The use of antiepileptic drugs in migraine prophylaxis. Why just some of them?

Introduction: Migraine is the most frequent manifestation of primary headaches. It is characterized by the recurrence of episodes which can last from 4 to 72 hours. Although it is a chronic recurrent disease, the number of episodes/month (?2) and the severity of its impact on the patient are the main factors taken into account when recommending prophylactic treatment. When choosing the medicine that best suits the patient, medical and psychiatric comorbidities should be borne in mind. Prophylactic use of antiepileptic drugs (AEDs) in migraine is based on the multiple actions of these drugs on the central nervous system; these multiple actions are relevant to the physiopathology of migraine. Objectives: To review essential aspects of AED pharmacology which are important in the physiopathology of migraine. Methods: The Cochrane Library Database and MedLine/PubMed data were reviewed. Results: AEDs are effective in reducing migraine episodes (reduction ? 50% of the episodes as well as reduction in the number of episodes needing rescue treatment). The prophylactic efficacy of these drugs depends on their modulating effect on GABA and glutamate and on their role in cortical NMDA receptors, which are responsible for the triggering and progression of spreading cortical depression, as well as in the caudal trigeminal nucleus. Conclusions: AEDs which are effective in the prophylaxis of migraine have a modulating action on spreading cortical depression (SCD) and on the trigeminovascular system and present good tolerability.

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