What anticonvulsants can help prevent migraine?

Donna Hill Howes, RN
Family Practitioner

Anticonvulsants are drugs used to treat seizures. Some of these are also effective for preventing migraines. Drugs that are FDA-approved for this use include valproic acid (Depakene, Depakote, Stavzor) and topiramate (Topamax).

Side effects may include loss of appetite, nausea, vomiting, diarrhea, and abdominal pain. Other side effects may include blurred or double vision, slurred speech, tremors, tingling sensations, problems with concentration or coordination, suicidal thoughts or behavior, and low red blood cell counts. Some people have allergic reactions that may be severe. Valproic acid has led to pancreatitis and liver failure. Metabolic acidosis has been reported in people taking topiramate.

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The anticonvulsant, or antiseizure, medications topiramate (Topamax) and divalproex (Depakote) are among the few medications specifically approved for migraine prevention. Another anticonvulsant used for migraine prevention is gabapentin (Neurontin), even though it is not specifically Food and Drug Administration (FDA)-approved for this use. Although the mechanisms are not entirely clear, anticonvulsants appear to work by reducing the transmission of pain signals in the brain.

The anticonvulsant, or antiseizure medication, divalproex (Depakote) tends to be about as effective as calcium-channel blockers (medication for high blood pressure, heart disease and migraine) in migraine prevention, although it's not as well tolerated. Its side effects can include nausea, diarrhea, weakness, weight gain, and tremor. Very rarely, it can cause potentially fatal liver failure. Consequently, people with liver disease shouldn't take this medication, and anyone who takes divalproex should have regular liver function tests. Women who are pregnant or trying to become pregnant shouldn't take this drug.

Topiramate (Topamax) and gabapentin (Neurontin) don't impair liver function, but these medications have other side effects to consider. One risk to keep in mind: topiramate may encourage the formation of kidney stones, so people taking it should drink plenty of fluids. Even so, topiramate and gabapentin offer an alternative for people who cannot tolerate or do not respond to divalproex.

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