Gabapentin for Migraine and Gabapentin for Migraine Dosage

Gabapentin 800 mg Tab-IVA

Gabapentin is is an antiepileptic drug, prescribed as adjunctive therapy in the treatment of partial seizures with and without secondary generalization in patients over 12 years of age with epilepsy. Neurontin is also indicated as adjunctive therapy in the treatment of partial seizures in pediatric patients age 3-12 years.. It is typically added to the treatment regimen when other drugs fail to fully control a patient’s attacks.

Gabapentin is a drug that’s approved to help prevent seizures in people with epilepsy and treat nerve pain from shingles. It’s also sometimes used off-label for migraine prevention.

Gabapentin belongs to a class of drugs called anticonvulsants. A class of drugs is a group of medications that work in a similar way. Anticonvulsants help calm nerve impulses. It’s believed that this action may help prevent migraine pain.

This drug comes as a capsule, tablet, or solution. You take it by mouth. Gabapentin is available as the brand-name drugs Neurontin, Gralise, and Horizant. It’s also available as a generic drug.

How gabapentin works to prevent migraine attacks ?

Gabapentin’s role in migraine prevention isn’t well known.

It’s believed that it may influence electrical activity in the brain through neurotransmitters and block calcium channels. It may also be a factor in reducing excitatory neurotransmitters like glutamate.

Still, more research needs to be done to determine why it works.

Generally, gabapentin isn’t used as a primary therapy for migraine prevention, but as an additional treatment to support other therapies.

The drugs used to prevent migraine attacks are different from drugs that treat an acute attack. Drugs that prevent migraine symptoms, such as gabapentin, must be taken on an ongoing basis to work properly.

Gabapentin dosage information for migraine

The dosage for gabapentin for migraine ranges from 300 to 3,600 milligrams (mg) per day, depending on your age and other health factors.

Gabapentin for migraine prevention can be taken with or without food and comes in an extended release tablet, an immediate release tablet, or an oral solution.

Side effects of gabapentin include:

  • vision changes such as blurred vision
  • unusual eye movements
  • ataxia (loss of coordination)
  • swelling in the limbs or feet

It’s important to follow your doctor’s recommendations on dosage and weaning off of the medication if needed. Never take more than is recommended by your doctor, even if you miss a dose.

Gabapentin is also quite effective in the treatment of cluster and chronic daily headaches.  Most people achieve the reduction of headache frequency within 1-2 weeks.

In one study, eight patients with intractable cluster headache were headache-free at a maximum of 8 days after starting gabapentin at the daily dose of 900 mg. Patients with the episodic type remained headache-free at 3 months after discontinuation of therapy. Patients with chronic cluster were headache-free during the 4 months after initiation of treatment while taking this medication.

The longest period of being continuously headache free on gabapentin was 18 months

gabapentin-300Since this is a relatively new way to use some of the newer neuronal stabilizers (anticonvulsants) such as Neurontin® (gabapentin) (As well as others such as Topamax® (topiramate), Lamictal® (lamotrigine) and Gabatril® (tiagabine)) prophylactically for Migraine disease, the dosage will be directed by your physican. Having noted that we will post recommend clinical practice guidelines for use as soon as we get that information from the manufacturer, FDA or AHS. his anticonvulsant is a prophylactic drug for treatment of migraine (Silberstein, 2000).  Gabapentin (strangely enough) does not affect Gaba-b receptors or other commonly studied receptors. It may nevertheless increase glutamate-dependent GABA synthesis and it also binds to the calcium channel. Adverse effects include sleepiness, dizziness, fatigue and weight gain associated with increased appetite. A newer version of Neurontin is “Lyrica”. This is basically a far more expensive version of gabapentin with a few advantages. Imbalance is common as a side effect of Lyrica. Pregnancy category C.

It reduces the frequency of headaches, pain intensity, and the use of symptomatic medications. Gabapentin is a good preventive therapy for migraines refractory to other medications.

Current Canadian Headache Society guideline for migraine prophylaxis rate gabapentin as strongly recommended prophylactic treatment with moderate quality evidence.

Mechanism of migraine prophylaxis

Experimental research suggests that gabapentin reduces neuronal excitability in spinal trigeminal nuclei and prevents central sensitization during migraine attack.

Gabapentin dosage: 1,200 mg to 2,400 mg per day divided in three doses.

Following is the Reviews of Gabapentin for Migraine from some patients in drugs.com

“I’ve had headaches since I was 6 years old. Cluster headaches almost every single day. Migraines once or twice a week. I went to so many doctors, went through so many scans, and tests that I actually learned to read MRI sheets before I was a teenager. Apparently there’s nothing physically wrong. So I went to PT, and chiropractors and they only helped a bit. At 14 I was old enough to start taking the harsher pills. Most turned me into a zombie. And I’ve only stuck with two in the end. I have just started having hand joint pains, and possible carpal tunnel, so I was put on a very high dose of Gabapentin. Two days later, headaches were gone. No rhyme or reason. Poof. It makes zero sense, but it’s a miracle drug. 100/10 would refer to anyone”

gabapentin-memory-loss“I started having migraine headaches when I was 14. The first time I had one, I was sitting in Biology class and could not see the faces of other students around me. I was terrified and had a panic attack. The school nurse thought I was on drugs and called my mother who immediately took me to a doctor. The migraines continued through out my life and caused me difficulty in my employment. I am a solo practitioner lawyer. When I would get one in court, I could not see, speak or think. Obviously, I had migraines with an aura. My family doctor only treated the pain, but finally I went to a psychiatrist and he prescribed Gabapentin and Lexapro. My migraines stopped completely. It has been seven months now and I am migraine free.”

If topiramate or propranolol are unsuitable or ineffective, you may be prescribed a medication called gabapentin. Like topiramate, this is a medication that is normally used to treat people with epilepsy that may also help prevent migraines. It is usually taken every day in tablet form.

Most people can take gabapentin, but it should be used with caution in people with kidney problems and those over 65 years of age.

Side effects of gabapentin can include dizziness, drowsiness, increased appetite, weight gain and suicidal thoughts.

Gabapentin has been recommended as a possible treatment for migraines by the National Institute for Health and Care Excellence (NICE), but recent research has suggested it may not be effective in preventing attacks and concerns have been raised about the quality of earlier research into the medication.

“I have been having chronic migraines for 5 years now and probably 50 other prescriptions wrote for me and finally gabapentin is like a miracle for me.My migraines were 24/7 with tension in shoulders and neck. Felt little tired and strange first day but great relief now. My doctor and neurologist all but gave up on me and was filling pretty depressed. Thank you gabapentin!!!!!”

“I had been taking topomax and Botox injections. They helped initially, the Botox helps within one week, sometimes two. I got injections ev’y 3 mths. Quit working after awhile. Now on gabapentin. Seems to be helping somewhat on higher dose but weight gain is horrible! I do not have increased appetite nor eat more either. Not sure what to do about it. Can’t keep increasing weight.”

How To Discontinue Gabapentin

Like other psychotropic drugs, you should ease off gabapentin gradually. There are some known withdrawal symptoms. This mostly comes from people who take high doses of the drug and suddenly stop. You should only abruptly discontinue this drug because of a serious side effect, and even then, it should be done with your doctor’s supervision and direction.

Gabapentin Dosage and Administration

Typically, your doctor will prescribe 300 mg once a day, usually in the evening, to start. The dose will then be increased every three to five days. Some people will take 600 mg/day, others will increase to 3,600 mg/day—the maximum dose approved by the FDA.

If used as a mood stabilizer or anti-depressant, the dose is usually between 900 and 2,000 mg a day. But, it may also be increased for better results. Some people see improvement in their symptoms about a week after starting treatment. Others need about a month before they see significant improvement.

Gabapentin has a half-life of about six hours, so it must be taken three to four times a day.

Gabapentin Overdose and Toxicity

It’s possible to fatally overdose on gabapentin. Reports of gabapentin being abused alone, and with opioids, prompted the FDA to release a warning statement (in December 2019) about the fatal risk of respiratory depression. Signs of overdose include:

  • Ataxia (decreased muscle coordination)
  • Diarrhea
  • Drooping eyelid
  • Drowsiness and lethargy
  • Double vision
  • Excitation
  • Hypoactivity
  • Labored breathing
  • Marked sedation
  • Slurred speech

If you suspect an overdose, you need immediate medical treatment. The only way to remove the drug is through kidney dialysis in the emergency room.

Gabapentin and Alcohol Use Disorder

Gabapentin may be helpful in treating alcohol use disorder and withdrawal. Between 2004 and 2010, The Veterans Affairs Department conducted a double-blind, placebo-controlled, randomized dose-ranging trial of 150 men and women over 18, struggling with alcohol dependence.3 The results of the study showed that gabapentin (particularly the 1800 mg dosage) was effective in safely treating alcohol dependence and relapse-related symptoms including insomnia, dysphoria, and cravings.

 

What is Gabapentin and What It is Used for ?

US Brand Name

      1. FusePaq Fanatrex
      2. Gabarone
      3. Gralise
      4. Neurontin

Descriptions

Gabapentin is used to help control partial seizures (convulsions) in the treatment of epilepsy. This medicine cannot cure epilepsy and will only work to control seizures for as long as you continue to take it.

Gabapentin is also used to manage a condition called postherpetic neuralgia, which is pain that occurs after shingles.

Gabapentin works in the brain to prevent seizures and relieve pain for certain conditions in the nervous system. It is not used for routine pain caused by minor injuries or arthritis. Gabapentin is an anticonvulsant.

This medicine is available only with your doctor’s prescription.

This product is available in the following dosage forms:

      • Capsule
      • Tablet
      • Solution
      • Suspension

Gabapentin capsules, tablets, and oral solution are used along with other medications to help control certain types of seizures in people who have epilepsy. Gabapentin capsules, tablets, and oral solution are also used to relieve the pain of postherpetic neuralgia (PHN; the burning, stabbing pain or aches that may last for months or years after an attack of shingles). Gabapentin extended-release tablets (Horizant) are used to treat restless legs syndrome (RLS; a condition that causes discomfort in the legs and a strong urge to move the legs, especially at night and when sitting or lying down).

Gabapentin is in a class of medications called anticonvulsants. Gabapentin treats seizures by decreasing abnormal excitement in the brain. Gabapentin relieves the pain of PHN by changing the way the body senses pain. It is not known exactly how gabapentin works to treat restless legs syndrome.

Gabapentin Dosage and Administration

Typically, your doctor will prescribe 300 mg once a day, usually in the evening, to start. The dose will then be increased every three to five days. Some people will take 600 mg/day, others will increase to 3,600 mg/day—the maximum dose approved by the FDA.

If used as a mood stabilizer or anti-depressant, the dose is usually between 900 and 2,000 mg a day. But, it may also be increased for better results. Some people see improvement in their symptoms about a week after starting treatment. Others need about a month before they see significant improvement.

Gabapentin has a half-life of about six hours, so it must be taken three to four times a day.

How To Discontinue Gabapentin

Like other psychotropic drugs, you should ease off gabapentin gradually. There are some known withdrawal symptoms. This mostly comes from people who take high doses of the drug and suddenly stop. You should only abruptly discontinue this drug because of a serious side effect, and even then, it should be done with your doctor’s supervision and direction.

Gabapentin Overdose and Toxicity

It’s possible to fatally overdose on gabapentin. Reports of gabapentin being abused alone, and with opioids, prompted the FDA to release a warning statement (in December 2019) about the fatal risk of respiratory depression. Signs of overdose include:

  • Ataxia (decreased muscle coordination)
  • Diarrhea
  • Drooping eyelid
  • Drowsiness and lethargy
  • Double vision
  • Excitation
  • Hypoactivity
  • Labored breathing
  • Marked sedation
  • Slurred speech

If you suspect an overdose, you need immediate medical treatment. The only way to remove the drug is through kidney dialysis in the emergency room.

The off-lable use of Gabapentin for migraine

Neurontin is prescribed for the treatment of the following conditions in adults and children over 3 years:

Various forms of epilepsy. When used for controlling epilepsy, it is usually used in conjunction with another anti-epileptic drug.   Usually doctors prescribe prescribe Neurontin for patients to help them to treat your epilepsy when a current treatment is not fully controlling his/her condition. Neurontin is used as addition to the main treatment of epilepsy.

Peripheral neuropathic pain (long lasting pain caused by damaged nerves). This disease can occur and develop in various conditions: injury, diabetes, shingles, and others.

Your doctor may prescribe you Neurontin for the treatment of other diseases, if he thinks that it is a right medicine for your case which is offl-label use of Neurontin.

It is also widely used to treat Anxiety and Migraine prevention.

Gabapentin Off-Label Usage

One of Gabapentin “off-label” usage is for migraine prevention and treatment, including migraines with or without aura, vestibular migraines. It can reduce the frequency of headaches, pain intensity, and the use of symptomatic medications. Gabapentin is a good preventive therapy for migraines refractory to standard medications.

The chemical structure of gabapentin is related that of gamma-aminobutyric acid (GABA) which is a neurotransmitter in the brain. The exact mechanism as to how gabapentin controls epilepsy and relieves pain is unknown, but it probably acts like the neurotransmitter GABA.

The effective dose of gabapentin varies greatly. Some persons need only 200-300 mg a day whereas others may need 3000 mg or more a day. It may take several weeks to become effective, so it is important to stay on it for an adequate length of time.

The Efficacy of gabapentin in migraine prophylaxis experiment shows  gabapentin is an effective prophylactic agent for patients with migraine.

In the Clinical trials143 patients evaluated gabapentin for migraine prophylaxis.  After 3 months the patients taking gabapentin had a reduction of the migraine frequency by 1.5 migraines per month (or by 35.7%) compared with a reduction of 0.6 migraines per month for the placebo group. Also, gabapentin reduced the headache frequency by 50% or greater in 45% patients compared with only 16% patients on placebo. The most frequently reported adverse events  were asthenia, dizziness, somnolence, and infection.

Can Gabapentin be Used for Anxiety, Depression, and Bipolar Disorder ?

Gabapentin is an anticonvulsant prescription drug that goes by several brand names including, Neurontin, Gralise, Gabarone, and Fanatrex.

It was approved by the FDA in December 1993 for the following main uses.

    1. Controlling certain types of seizures in people who have epilepsy
    2. Relieving nerve pain (think: burning, stabbing, or aches) from shingles
    3. Calming restless legs syndrome

But since it’s been available, gabapentin has also been used off-label in psychiatry to treat patients with treatment-resistant mood and anxiety disorders as well as alcohol-withdrawal and post-traumatic stress. It works by decreasing abnormal excitement in the brain for seizures and changing the way the body senses pain for nerve pain. Researchers don’t know exactly how it works for psychiatric conditions. (*Note: Some states have recently classified gabapentin as a controlled substance due to the potential for it to be abused and contribute to death from overdose.)

Treatment with Gabapentin: Important Things to Know Before Taking Gabapentin

Before you start gabapentin therapy, you should have a thorough medical exam to rule out any medical issues. This includes any blood or urine tests. Medical evaluations are important as gabapentin can induce hormonal imbalances. Like any other drug, you should not take gabapentin if you’re allergic to it.

There are side effects—more on that in a minute. But a few of the most important things your doctor will want to find out before prescribing gabapentin is if you have or have had any of the following:

    • Diabetes
    • Drug or alcohol addiction
    • Kidney problems (or if you’re on dialysis)
    • Liver or heart disease
    • Lung disease (see the warning above on respiratory issues)
    • Mood disorders, depression or bipolar; or if you’ve ever thought about suicide or attempted suicide
    • Seizures (unless, of course, you’re taking it for seizures)

You should also know that not enough studies have been done to understand the exact risks of gabapentin if you’re pregnant or breastfeeding.

How Gabapentin Is Used to Treat Anxiety Mood Disorders Like Depression

Gabapentin isn’t usually used to treat anxiety alone. More often, it’s given to ease anxiety symptoms for someone who also has depression or bipolar disorder. (Anxiety is common comorbid with depression and bipolar.) The reason is that it may not be effective for just anxiety. A close look comparing seven different clinical trials on how successful gabapentin is for anxiety shows that gabapentin may be better than a placebo to treat generalized anxiety disorder (GAD), but not much better. Results may be slightly more promising for social anxiety disorder.

The clinical trials for treating depression with gabapentin are also pretty lackluster. To date, there are no scientific studies showing it’s effective—either on its own or as part of some other therapy. Still, there is some anecdotal evidence that it’s helpful, especially with patients who don’t seem to improve with more standard antidepressants.

How Gabapentin Is Used to Treat Mixed Bipolar States

More specifically, can it prevent future episodes of mania and depression? Right now, there is no good evidence that gabapentin can be used for treating people with bipolar disorder. High-quality, randomized controlled studies found that gabapentin was not effective.1,2

Gabapentin and Alcohol Use Disorder

Gabapentin may be helpful in treating alcohol use disorder and withdrawal. Between 2004 and 2010, The Veterans Affairs Department conducted a double-blind, placebo-controlled, randomized dose-ranging trial of 150 men and women over 18, struggling with alcohol dependence.3 The results of the study showed that gabapentin (particularly the 1800 mg dosage) was effective in safely treating alcohol dependence and relapse-related symptoms including insomnia, dysphoria, and cravings.

Gabapentin for Fibromyalgia

Research suggests that people with fibromyalgia have too much glutamate in certain parts of their brain, so gabapentin has long been prescribed for it. But is it effective? Research is mixed.

Two reviews of the evidence disagree. One released in 2016 found that gabapentin is an effective fibromyalgia treatment,3 while another, published in 2017,4 reported only low-quality evidence.

In studies comparing gabapentin with pregabalin (Lyrica), including one published in The Journal of the American Medical Association, pregabalin appeared to perform better.

Gabapentin Dosage

Gabapentin is usually started at a low dose and then gradually increased. Be sure to follow your doctor’s instructions. A typical dose ranges between 900 mg and 1,800 mg daily, divided into three doses. You shouldn’t stop taking gabapentin suddenly. Be sure to talk to your doctor about the proper weaning procedure for the dose you’re taking.

Gabapentin Side Effects

Like all drugs, gabapentin comes with a risk of side effects.5 Some are potentially dangerous, while others are not. If you have any of the following side effects while taking gabapentin, call your doctor immediately:

  • Severe weakness or tiredness
  • Upper stomach pain
  • Chest pain
  • New or worsening cough along with fever
  • Difficulty breathing
  • Severe tingling or numbness
  • Rapid, back-and-forth eye movements
  • Pain or difficulty with urination, or no urination
  • Fever
  • Sore throat
  • Swelling in the face or tongue
  • Burning eyes
  • Rash

Side effects that aren’t cause for immediate concern include:

  • Fatigue
  • Dizziness
  • Headache
  • Falling asleep
  • Weight gain

Children taking gabapentin may experience a different set of side effects. Contact your doctor immediately for the following:

  • Changes in behavior
  • Memory problems
  • Inability to concentrate
  • Restlessness, hostility, or aggression

Gabapentin may react negatively with other drugs. Be sure your doctor and pharmacist know everything you’re taking.

Is Gabapentin Right for You?

With evidence being weak and mixed, gabapentin has one clear advantage over Lyrica—it’s generic, and therefore much less expensive. Price, however, is far less important than efficacy.

We all react differently to medications. Some people who fail on other drugs, including Lyrica, may find relief from gabapentin. Talk to your doctor about the benefits and drawbacks gabapentin may have for your overall treatment regimen.