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Refining the Benefit/Risk Profile of Anti-Epileptic Drugs in Headache Disorders

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Abstract

Anti-epileptic drugs are among the most effective drugs for migraine prophylaxis, and will likely continue to have a role even as new therapies emerge. Topiramate and valproate are effective for the preventive treatment of migraine, and other medications such as gabapentin or lamotrigine may have a role in the treatment of those with allodynia or frequent aura, respectively. Oxcarbazepine, carbamazepine, phenytoin, gabapentin, and others may alleviate pain in trigeminal neuralgia. While many anti-epileptic drugs can be effective in those with migraine or other headaches, most of these agents can potentially cause serious side effects. In particular, valproate, topiramate, carbamazepine, and phenytoin may lead to adverse outcomes for infants of exposed mothers. Valproate should not be given to women of childbearing potential for migraine prevention.

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Authors and Affiliations

  1. Department of Neurology, Jefferson Headache Center, Thomas Jefferson University, 900 Walnut ST #200, Philadelphia, PA, 19107, USA

    Michael J. Marmura & Aliza S. Kumpinsky

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  1. Michael J. Marmura
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  2. Aliza S. Kumpinsky
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Correspondence to Michael J. Marmura.

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Michael J. Marmura has received compensation for consultations from Teva, Supernus, Amgen, GammaCore, Promius, Alder, and Valeant. He has also received compensation for speaker bureau participation from Amgen. Aliza S. Kumpinsky has no conflicts of interest directly relevant to the contents of this article.

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Marmura, M.J., Kumpinsky, A.S. Refining the Benefit/Risk Profile of Anti-Epileptic Drugs in Headache Disorders. CNS Drugs 32, 735–746 (2018). https://doi.org/10.1007/s40263-018-0555-z

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