Gabapentin is is an antiepileptic drug, prescribed as adjunctive therapy in the treatment of partial seizures with and without secondary generalization in patients over 12 years of age with epilepsy. Neurontin is also indicated as adjunctive therapy in the treatment of partial seizures in pediatric patients age 3-12 years.. It is typically added to the treatment regimen when other drugs fail to fully control a patient’s attacks.
Gabapentin is a drug that’s approved to help prevent seizures in people with epilepsy and treat nerve pain from shingles. It’s also sometimes used off-label for migraine prevention.
Gabapentin belongs to a class of drugs called anticonvulsants. A class of drugs is a group of medications that work in a similar way. Anticonvulsants help calm nerve impulses. It’s believed that this action may help prevent migraine pain.
This drug comes as a capsule, tablet, or solution. You take it by mouth. Gabapentin is available as the brand-name drugs Neurontin, Gralise, and Horizant. It’s also available as a generic drug.
How gabapentin works to prevent migraine attacks ?
Gabapentin’s role in migraine prevention isn’t well known.
It’s believed that it may influence electrical activity in the brain through neurotransmitters and block calcium channels. It may also be a factor in reducing excitatory neurotransmitters like glutamate.
Still, more research needs to be done to determine why it works.
Generally, gabapentin isn’t used as a primary therapy for migraine prevention, but as an additional treatment to support other therapies.
The drugs used to prevent migraine attacks are different from drugs that treat an acute attack. Drugs that prevent migraine symptoms, such as gabapentin, must be taken on an ongoing basis to work properly.
Gabapentin dosage information for migraine
The dosage for gabapentin for migraine ranges from 300 to 3,600 milligrams (mg) per day, depending on your age and other health factors.
Gabapentin for migraine prevention can be taken with or without food and comes in an extended release tablet, an immediate release tablet, or an oral solution.
Side effects of gabapentin include:
- vision changes such as blurred vision
- unusual eye movements
- ataxia (loss of coordination)
- swelling in the limbs or feet
It’s important to follow your doctor’s recommendations on dosage and weaning off of the medication if needed. Never take more than is recommended by your doctor, even if you miss a dose.
Gabapentin is also quite effective in the treatment of cluster and chronic daily headaches. Most people achieve the reduction of headache frequency within 1-2 weeks.
In one study, eight patients with intractable cluster headache were headache-free at a maximum of 8 days after starting gabapentin at the daily dose of 900 mg. Patients with the episodic type remained headache-free at 3 months after discontinuation of therapy. Patients with chronic cluster were headache-free during the 4 months after initiation of treatment while taking this medication.
The longest period of being continuously headache free on gabapentin was 18 months
Since this is a relatively new way to use some of the newer neuronal stabilizers (anticonvulsants) such as Neurontin® (gabapentin) (As well as others such as Topamax® (topiramate), Lamictal® (lamotrigine) and Gabatril® (tiagabine)) prophylactically for Migraine disease, the dosage will be directed by your physican. Having noted that we will post recommend clinical practice guidelines for use as soon as we get that information from the manufacturer, FDA or AHS. his anticonvulsant is a prophylactic drug for treatment of migraine (Silberstein, 2000). Gabapentin (strangely enough) does not affect Gaba-b receptors or other commonly studied receptors. It may nevertheless increase glutamate-dependent GABA synthesis and it also binds to the calcium channel. Adverse effects include sleepiness, dizziness, fatigue and weight gain associated with increased appetite. A newer version of Neurontin is “Lyrica”. This is basically a far more expensive version of gabapentin with a few advantages. Imbalance is common as a side effect of Lyrica. Pregnancy category C.
It reduces the frequency of headaches, pain intensity, and the use of symptomatic medications. Gabapentin is a good preventive therapy for migraines refractory to other medications.
Current Canadian Headache Society guideline for migraine prophylaxis rate gabapentin as strongly recommended prophylactic treatment with moderate quality evidence.
Mechanism of migraine prophylaxis
Experimental research suggests that gabapentin reduces neuronal excitability in spinal trigeminal nuclei and prevents central sensitization during migraine attack.
Gabapentin dosage: 1,200 mg to 2,400 mg per day divided in three doses.
Following is the Reviews of Gabapentin for Migraine from some patients in drugs.com
“I’ve had headaches since I was 6 years old. Cluster headaches almost every single day. Migraines once or twice a week. I went to so many doctors, went through so many scans, and tests that I actually learned to read MRI sheets before I was a teenager. Apparently there’s nothing physically wrong. So I went to PT, and chiropractors and they only helped a bit. At 14 I was old enough to start taking the harsher pills. Most turned me into a zombie. And I’ve only stuck with two in the end. I have just started having hand joint pains, and possible carpal tunnel, so I was put on a very high dose of Gabapentin. Two days later, headaches were gone. No rhyme or reason. Poof. It makes zero sense, but it’s a miracle drug. 100/10 would refer to anyone”
“I started having migraine headaches when I was 14. The first time I had one, I was sitting in Biology class and could not see the faces of other students around me. I was terrified and had a panic attack. The school nurse thought I was on drugs and called my mother who immediately took me to a doctor. The migraines continued through out my life and caused me difficulty in my employment. I am a solo practitioner lawyer. When I would get one in court, I could not see, speak or think. Obviously, I had migraines with an aura. My family doctor only treated the pain, but finally I went to a psychiatrist and he prescribed Gabapentin and Lexapro. My migraines stopped completely. It has been seven months now and I am migraine free.”
If topiramate or propranolol are unsuitable or ineffective, you may be prescribed a medication called gabapentin. Like topiramate, this is a medication that is normally used to treat people with epilepsy that may also help prevent migraines. It is usually taken every day in tablet form.
Most people can take gabapentin, but it should be used with caution in people with kidney problems and those over 65 years of age.
Side effects of gabapentin can include dizziness, drowsiness, increased appetite, weight gain and suicidal thoughts.
Gabapentin has been recommended as a possible treatment for migraines by the National Institute for Health and Care Excellence (NICE), but recent research has suggested it may not be effective in preventing attacks and concerns have been raised about the quality of earlier research into the medication.
“I have been having chronic migraines for 5 years now and probably 50 other prescriptions wrote for me and finally gabapentin is like a miracle for me.My migraines were 24/7 with tension in shoulders and neck. Felt little tired and strange first day but great relief now. My doctor and neurologist all but gave up on me and was filling pretty depressed. Thank you gabapentin!!!!!”
“I had been taking topomax and Botox injections. They helped initially, the Botox helps within one week, sometimes two. I got injections ev’y 3 mths. Quit working after awhile. Now on gabapentin. Seems to be helping somewhat on higher dose but weight gain is horrible! I do not have increased appetite nor eat more either. Not sure what to do about it. Can’t keep increasing weight.”
International and domestic studies that have evaluated Neurontin for migraine prevention suggest that it is effective. In a study of 63 patients with migraine (with or without aura), gabapentin significantly reduced migraine frequency and intensity among 30 patients who received it. In this study, adverse events were mild to moderate in severity.
Similarly, in a large study, 143 people with migraine received daily doses of Neurontin or placebo for 12 weeks. At the end of 12 weeks, the migraine rate had declined from 4.2 migraines before treatment to 2.7 migraines after treatment in those who received this drug. This decrease was significantly greater than the decrease from 4.1 migraines to 3.5 migraines among those who received placebo. Of the 56 gabapentin recipients, 46% had at least a 50% reduction in the four-week migraine rate. Drug-related adverse events (sleepiness and dizziness) led to drug withdrawal in 13% of patients in the gabapentin group compared with 7% in the placebo group. The researchers concluded that this medication is an effective and well-tolerated preventive for migraine.
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