An Overview of Gabapentin

This seizure medication may be used in the treatment of migraines

In the quest to find effective preventive migraine treatments, doctors sometimes prescribe medications "off-label." In these cases, a drug has been approved by the U.S. Food and Drug Administration (FDA) for one disorder, but has been found to have positive effects on an unrelated one. Gabapentin is one such drug. It's an anti-seizure drug sometimes used to prevent migraines, though there is scant scientific supporting its effectiveness in this regard.

In the United States, gabapentin is sold in generic form and under the brand names Neurontin, Gralise, Horizant, and Neuraptine.

Uses

Gabapentin is primarily used to treat seizures, and it is also FDA-approved to treat a condition called postherpetic neuralgia—the nerve-related pain complication of a herpes zoster attack (shingles).

Besides these uses, gabapentin is used off-label for a variety of other conditions like migraine prevention, as well as diabetic neuropathy, restless legs syndrome, and fibromyalgia.

Because of its benefit in treating these and other issues, gabapentin is what's known as an adjuvant analgesic—a drug that can help control pain, despite it not being primarily intended to do so.

Formulation and Dosing

Gabapentin is taken by mouth and available as a capsule, tablet, or liquid. Dosages range from 100mg to 800mg.

Experts estimate that up to 40 percent of the 80 million Americans with migraines should be on migraine preventive medications, but research suggests that only between 3 percent and 13 percent of people with migraines are on preventive therapy.

Adverse Effects

Like all drugs, gabapentin does have potential adverse effects, with the most common ones being dizziness and drowsiness. More rare, but serious, side effects include:

  • Loss of coordination
  • Blurred/double vision
  • Unusual eye movements, or shaking (tremor) 
  • Swelling of the hands, ankles, or feet

    Tell your doctor right away if any of these side effects occur.

    Interactions

    Types of drugs that are known to interact with gabapentin and may cause problems include:

    • Opiate pain medications, including Vicodin (hydrocodone) and morphine, among others
    • Naproxen (Aleve, Naprosyn, and others)
    • Medications used for heartburn, including Mylanta, Maalox, and cimetidine

    If you do dipstick tests to check your urine for protein, tell your doctor. Gabapentin may affect the results of some of these types of tests.

    Drinking alcohol may make some side effects of gabapentin more severe. 

    Contraindications

    Currently, the (FDA) classifies gabapentin as a pregnancy category C drug, indicating there is not enough research or well-controlled studies on humans to deem this medication safe. 

    Gababentin should not be taken by people with chronic kidney disease or myasthenia gravis.

    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.

    Warnings

    A small number of people who take anticonvulsants for any condition may experience depression, suicidal thoughts/attempts, or other mental/mood problems. Tell your doctor right away if you or a loved one notice any unusual or sudden changes in your mood, thoughts, or behavior including signs of depression, suicidal thoughts, or thoughts about harming yourself.

    A very serious allergic reaction to gabapentin is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face, tongue, or throat), severe dizziness, or trouble breathing.

    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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