Antiepileptic drugs in migraine: from clinical aspects to cellular mechanisms.
ABSTRACT Migraine and epilepsy share several clinical features, and epilepsy is a comorbid condition of migraine. Clinical studies have shown that some antiepileptic drugs are effective at preventing migraine attacks. A rationale for their use in migraine prophylaxis is the hypothesis that migraine and epilepsy share several common pathogenetic mechanisms. An imbalance between excitatory glutamate-mediated transmission and GABA-mediated inhibition in specific brain areas has been postulated in these two pathological conditions. Moreover, abnormal activation of voltage-operated ionic channels has been implicated in both migraine and epilepsy. Cortical spreading depression has been found to be involved in the pathophysiology of epilepsy, in addition to the generation of migraine aura.
Article: Migrende Profilaktik TedaviNoropsikiyatri Arsivi 08/2013; 50(1):30-35. DOI:10.4274/npa.y7199 · 0.13 Impact Factor
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ABSTRACT: Introduction: Migraine has a strong social impact, influencing both quality of life and work productivity. Therapeutic approach of migraine consists of a multimodal program of pharmacotherapy and behavioral therapy in order to reduce the risk of chronification. Indications for the use of preventive therapy are three or more attacks per month, significant disability, attack duration that is > 90 min. Areas covered: In this review, studies conducted on sodium channel antagonists for the prophylaxis of migraine are selected using the International Classification of Headache Disorders (ICHD)-I and -II diagnostic criteria for migraine and are open-label and placebo-controlled studies. Expert opinion: Several sodium channel antagonists, such as valproic acid, topiramate, lamotrigine, zonisamide, carbamazepine and oxcarbazepine, are widely used in migraine although without similar level of efficacy. Among these antiepileptic drugs, valproic acid and topiramate seem to be more effective in migraine, as reported in the majority of controlled studies. In spite of their high efficacy rate, important side effects should be always monitored, especially depression, cognitive functions, weight gain, sleepiness and dizziness. The usefulness of this class drug will be dramatically improved by using ongoing data on individual pharmacogenomics profile.Expert Opinion on Pharmacotherapy 06/2014; 15(12):1-10. DOI:10.1517/14656566.2014.929665 · 2.86 Impact Factor
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ABSTRACT: Migraine is one of the most common forms of primary headaches; it affects nearly 10% of the population in developed countries. All major CNS neurotransmitter systems are implicated in migraine pathogenesis, indicating the polyneurochemical nature of the nosology. This review is focused on the role of gamma-aminobutyric acid (GABA) and its receptors in the neurobiology of migraine. The report describes evidence for the existence of a cause-effect relationship between impaired GABA metabolism and development of the disease. It summarizes data on the distribution of GABA-A and GABA-B receptors in the trigeminovascular system and on the contribution of GABA to the modulation of nociceptive neurotransmission in the trigemino-thalamo-cortical pathway. As well, it provides detailed information on the mechanisms that underlie GABA-ergic inhibition at the peripheral, spinal, and suprasegmental levels. In the end, we discuss the pharmacodynamics of some GABA-positive drugs that are used for prophylactic and acute treatments of migraine, as well as other primary headaches.Neurochemical Journal 04/2014; 8(2):89-102. DOI:10.1134/S1819712414020093 · 0.19 Impact Factor