Title:Antiseizure Medications for the Prophylaxis of Migraine during the Anti-
CGRP Drugs Era
Volume: 21
Issue: 8
Author(s): Eleonora Rollo, Marina Romozzi, Catello Vollono, Paolo Calabresi, Pierangelo Geppetti and Luigi F. Iannone*
Affiliation:
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence,
Italy
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence, Italy
Keywords:
Antiseizure-medications, epilepsy, migraine, calcitonin gene-related peptide, glutamate, GABA, pharmacodynamic.
Abstract: Migraine and epilepsy are fundamentally distinct disorders that can frequently coexist in the
same patient. These two conditions significantly differ in diagnosis and therapy but share some widely-
used preventive treatments. Antiseizure medications (ASMs) are the mainstay of therapy for epilepsy,
and about thirty different ASMs are available to date. ASMs are widely prescribed for other neurological
and non-neurological conditions, including migraine. However, only topiramate and valproic
acid/valproate currently have an indication for migraine prophylaxis supported by high-quality evidence.
Although without specifically approved indications and with a low level of evidence or recommendation,
several other ASMs are used for migraine prophylaxis. Understanding ASM antimigraine
mechanisms, including their ability to affect the pro-migraine calcitonin gene-related peptide (CGRP)
signaling pathway and other pathways, may be instrumental in identifying the specific targets of their
antimigraine efficacy and may increase awareness of the neurobiological differences between epilepsy
and migraine. Several new ASMs are under clinical testing or have been approved for epilepsy in recent
years, providing novel potential drugs for migraine prevention to enrich the treatment armamentarium
and drugs that inhibit the CGRP pathway.