An update on migraine treatment

Abstract

Although some pharmacologic treatments are used for both migraine and epilepsy, fundamental differences in treatment approaches and treatment goals exist. Migraine treatment requires acute and/or preventive therapy, whereas most epilepsy treatments are preventive (the exception being status epilepticus treatment). Some of the most commonly used preventive migraine therapies are antiepileptic drugs (AEDs). The mechanism of migraine activation is not yet completely understood, but it is associated with central and peripheral sensitization. Migraine-preventive drugs may raise the threshold for migraine activation or stabilize the excitable/ sensitive nervous system. The biggest difference between the goals of migraine treatment and the goals of epilepsy treatment is the definition of treatment success-seizure free for epilepsy versus reduction in attack frequency, severity, and duration for migraine. This article discusses the principles of migraine-preventive therapy and the factors that affect drug choice, and compares them with the principles of epilepsy treatment. Only 2 AEDs (divalproex and topiramate) are approved by the US Food and Drug Administration for migraine prevention. The possibility of using a single drug to treat both disorders is a "therapeutic opportunity." However, given the differing and sometimes conflicting treatment principles and treatment goals that exist, the entire patient profile should be considered in determining not only optimal drug choice but also dosing and definition of treatment success.