In recent years, there has been a growing awareness that certain types of anti-seizure medicines or anti-epilepsy drugs (AEDs) may help in reducing migraine frequency and severity. Depakote is now approved for three indications, including epilepsy, migraine, and manic-depression. In cases of chronic headache where mood fluctuations are complicating the clinical picture, Depakote may be extremely valuable. In scenarios where beta blockers and calcium channel blockers should not be used for whatever reason, Depakote becomes an excellent substitute. Many neurologists now use Depakote as one of their first-line choices in the prevention of migraine.

MECHANISM OF ACTION

These drugs seem to work in two ways: (1) they elevate a brain chemical called GABA which has a dampening effect on the migraine generators, and (2) they seem to have a nonspecific effect in “quieting” the brain. In recent years, carefully controlled clinical studies have shown valproate (Depakote) as being very efficacious for the treatment of migraine headache.

SIDE EFFECTS

The most common initial side effect of Depakote is nausea and/or vomiting, but there is gradual reduction in this side effect as the treatment continues. Gradually increasing small doses over a period of two to three weeks is recommended. Most patients get benefit at a dosage of between 500 and 1,500 mg. daily. Other side effects may include tremor, weight gain, fatigue, and hair loss which may make Depakote less acceptable to certain individuals.

The fear of liver damage is unfounded in healthy people. There is no correlation between blood levels of Depakote and its clinical effect; therefore, estimation of blood levels is not absolutely necessary. However, it is recommended that blood count and liver enzymes be done periodically, preferably once every three to four months, to monitor any change in the liver function.

CONTRAINDICATIONS

The drug should not be used in the presence of hepatitis or other liver dysfunctions. This drug is contraindicated during pregnancy because of its effect on the fetus.

OTHER ANTI-SEIZURE MEDICATIONS

1. Gabapentin (Neurontin) has been shown to be effective in clinical trials for migraine prophylaxis. It has also been shown to increase the levels of GABA in the brain. Gabapentin is a well tolerated medicine, and dosages up to 2,400 mg. a day are used. 
2. Topiramate (Topamax) is also being used with increasing frequency in the treatment of migraine headache. This particular medication has the added benefit that may promote weight loss.

CONCLUSION

In the next decade, we can expect to see many more different types of anti-epilepsy medicines used in the prevention and treatment of migraine headache.