Can Gabapentin Prevent Migraines?

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Over 37 million Americans suffer from migraines, and experts estimate that up to 40 percent of them should be on migraine preventive medications. Unfortunately, research suggests that only between 3 and 13 percent of migraineurs are on preventive therapy.

This is partially due to the lack of truly effective migraine preventive drugs, as well as their often intolerable side effects—a double whammy.

Migraine researchers have been busy looking into better preventive drugs with fewer side effects. Gabapentin is one such drug that has been investigated with somewhat ambiguous findings.

What Is Gabapentin?

Gabapentin, available as the brand name Neurontin, Gralise, Horizant, and Neuraptine in the United States, is a medication FDA-approved to treat seizures. It's also FDA-approved to treat a condition called postherpetic neuralgia, which is the nerve-related pain complication of a herpes zoster attack (called shingles).

Besides seizures and postherpetic neuralgia, gabapentin is used off-label, for a variety of other conditions like migraine prevention, as well as diabetic neuropathy, restless leg syndrome, and fibromyalgia.

Gabapentin is taken by mouth and available as a capsule, tablet, or in solution form. Like all drugs, gabapentin does have potential adverse effects, with the most common ones being dizziness and drowsiness.

Research

When it comes to considering gabapentin as a migraine preventive drug, there is conflicting scientific evidence to support its use.

For example, a large review study in the Cochrane Database of Systematic Reviews pooled together multiple clinical trials of gabapentin used for migraine prevention in adults.

After examining data from over one thousand patients, the authors concluded that gabapentin was not beneficial for migraine prevention. This is because most of the studies showed no benefit of gabapentin compared to placebo when preventing migraine, and for those studies that did show a benefit, it was small.

In addition, the authors  of the study mentioned that due to the common occurrence of adverse effects in the studies analyzed, most notably somnolence and dizziness, "gabapentin should not be used in routine clinical practice."

Along with this review study, the American Academy of Neurology (AAN) and the American Headache Society (AHS) do not list gabapentin as "effective" or "probably effective," for preventing migraines in their 2012 guidelines. Instead, gabapentin is given a level U rating which means, the "evidence is conflicting or inadequate to support or refute the use of the following medications for migraine prevention."

On the flip side, Canadian Guidelines report gabapentin as having "strong, moderate-quality evidence" for migraine prevention based on its effectiveness and well-tolerated side effect profile. Gabapentin is thus recommended as second-line therapy in Canada, meaning a trial of gabapentin is reasonable if a trial of a different migraine preventive drug fails.

Alternative Options

Rest assured, despite the lacking support for gabapentin as a migraine preventive therapy in the United States, there are numerous other options available.

According to the AAN and AHS, below are some of the drugs they list as "effective," or "probably effective" for preventing migraines. Keep in mind, though, these drugs have their own unique side effect profiles and require a trial period of around three months before determining whether or not they are working.

  • Anticonvulsants like Depakote (divalproex sodium) and Topamax (topiramate)

  • Blood pressure medications (called β-Blockers) like metoprolol and propranolol

  • Anti-depressants like Elavil (amitriptyline) or Effexor (venlafaxine)

Migraine Prevention

On a more uplifting note, a whole new class of migraine preventive drugs is emerging. These drugs are antibodies that target calcitonin gene-related peptide (CGRP). CGRP is a small protein that is involved in both blood vessel dilation and pain signaling during a migraine attack. By blocking CGRP or its receptor sites, the goal is that a person's migraines will be reduced not only in number but also in duration and severity—and so far, the research is promising.

A Word From Verywell

Due to the lack of robust scientific findings, gabapentin's role in migraine prevention is not likely to be a doctor's first choice (or even second choice) when choosing a preventive medication.

If you are currently taking gabapentin for migraine prevention, and it's working for you, then you may be one of the fortunate ones—and that is OK. Keep in mind, guidelines are based on statistics from large populations, and cannot predict any one person's response.

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