Gabapentin for Migraine and Gabapentin for Migraine Dosage

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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.”

Gabapentin is Used primarily to Treat Seizures and Neuropathic Pain

Gabapentin is used primarily to treat seizures and neuropathic pain. It is also commonly prescribed for many off-label uses, such as treatment of anxiety disrders, insomnia, and bipolar disorder.

There are, however, concerns regarding the quality of the trials conducted and evidence for som such uses, especially in the case of its use as a mood stabilizer in bipolar disorder.

Seizures

Gabapentin is approved for treatment of focal seizures and mixed seizures. There is insufficient evidence for its use in generalized epilepsy.

Pain

A 2010 European Federation of Neurological Societies task force clinical guideline based on available evidence recommended gabapentin as a first-line treatment for diabetic neuropathy and postherpetic neuralgia with its highest level of evidence it also recommended gabapentin as a first-line treatment for central pain but with lower evidence. It also found good evidence that a combination of gabapentin and morphine or oxycodone or nortriptyline worked better than either drug alone; the combination of gabapentin and venlafaxine may be better than gabapentin alone.

A 2017 Cochrane review found evidence of moderate quality showing a reduction in pain by 50% in about 15% of people with postherpetic neuralgia and diabetic neuropathy. Evidence finds little benefit and significant risk in those with chronic low back pain. It is not known if gabapentin can be used to treat other pain conditions, and no difference among various formulations or doses of gabapentin was found.

A 2010 review found that it may be helpful in neuropathic pain due to cancer. It is not effective in HIV-associated sensory neuropathy and does not appear to provide benefit for complex regional pain syndrome.

A 2009 review found gabapentin may reduce opioid use following surgery, but does not help with post-surgery chronic pain. A 2016 review found it does not help with pain following a knee replacement.

It appears to be as effective as pregabalin and costs less.

All doses appear to result in similar pain relief.

Migraine

The American Headache Society (AHS) and American Academy of Neurology (AAN) guidelines classify gabapentin as a drug with “insufficient data to support or refute use for migraine prophylaxis. Furthermore, a 2013 Cochrane review concluded that gabapentin was not useful for the prevention of episodic migraine in adults.

Anxiety Disorders

Gabapentin has been used off-label for the treatment of anxiety disorders. However, there is dispute over whether evidence is sufficient to support it being routinely prescribed for this purpose.

 

Other Uses

Gabapentin may be useful in the treatment of comorbid anxiety in bipolar patients, (however not the bipolar state itself). Gabapentin may be effective in acquired pendular nystagmus and infantile nystagmus, (but not periodic alternating nystagmus). It is effective in hot flashes. It may be effective in reducing pain and spasticity in multiple sclerosis. Gabapentin may reduce symptoms of alcohol withdrawal (but it does not prevent the associated seizures).

There is some evidence for its role in the treatment of alcohol use disorder; the 2015 VA/DoD guideline on substance use disorders lists gabapentin as a “weak for” and is recommended as a second-line agent. Use for smoking cessation has had mixed results. Gabapentin is effective in alleviating itching in kidney failure (uremic pruritus) and itching of other causes. It is an established treatment of restless legs syndrome. Gabapentin may help sleeping problems in people with restless legs syndrome and partial seizures. Gabapentin may be an option in essential or orthostatic tremor.

Gabapentin is not effective alone as a mood-stabilizing treatment for bipolar disorder. There is insufficient evidence to support its use in obsessive compulsive disorder and treatment-resistant depression. Gabapentin does not appear effective for the treatment of tinnitus.

Migraine Headache Treatments and Prevention

Many people around the world suffer from migraine headaches. These headaches can often lead to a large amount of pain which can be debilitating for some people.

Migraines are affecting a huge percentage of people and the causes are usually determined on an individual basis. People often use acupuncture to reduce the severity of the migraine headaches and reduce the frequency that they occur. These alternative therapies can also be used to reduce the side effects of migraines such as sickness, stress, muscle tension and fatigue.

No matter what types of medication you take for migraine headaches they can produce unwanted side effects and symptoms. And unfortunately, they can also increase the intensity of the very pain they were intended to relieve.

There are many migraine headache triggers that will cause migraines and the first step toward eliminating this painful disorder is to determine what these triggers are and then eliminate them. Throbbing head pain is caused when the blood vessels surrounding the brain dilate. Placing a cold compress on the back of the neck can help minimize the flow of blood to the brain, thus relieving the throbbing pain.

There are other effective home remedies that can help reduce pain. Massaging tight muscles can aid in relaxation and the best spots for massage are the muscles of the neck, shoulders, face, and head. Be sure to use the pads of your fingers or thumbs and rub your muscles gently, but firmly. Another migraine treatment that has shown good results is taking niacin, also known as vitamin B3. If taken in sufficient amounts it can cause a person’s body to flush, or turn red. Before beginning a proper treatment for migraine headaches relief, it isn’t uncommon for sufferers to wind up in an emergency room because of the unendurable pain. Constrictions of blood vessels that supply the brain with blood are the likely root cause of migraines.

Migraines are a medical condition that impairs millions of people each year. While migraines differ in severity, common symptoms include altered perceptions, severe headaches, and nausea. Preventative migraine headache treatment options are used to prevent – or reduce – the number of migraines a person suffers from. Treatment usually is in the form of a medication or patch. Trigger management migraine treatments are aimed at identifying what causes migraines. Triggers can include a change of weather, air pressure, bright lights, glare, fluorescent light, fumes, and foods.

General pain management for migraine headache treatment can be used to treat non-life threatening migraines. Treatment options include the use of narcotic analgesics, non-steroidal anti-inflammatory drugs, and simple analgesics. As someone who has the unfortunate task of dealing with migraines you will surely be seeking some kind of migraine headache treatment to relieve yourself of the agony and pain that migraines come bearing when they do attack.

This option as it suggests should offer you more pleasant results compared to medicine. There are a number of techniques that have been researched by many migraine sufferers like applying heat or cold to the affected area and many more.

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Not all migraine cases are the same. One way to distinguish them is to determine whether or not you experience an aura.

So-called “complicated” migraine attacks begin with an aura. These can be visual distortions such as dots, wavy lines, or zig zags. Some people experience numbness or tingling across one side of the body. If they accompany headaches, auras usually appear about an hour earlier. If they do not, these auras are called “ocular migraines.”

About a quarter of people diagnosed with migraine (“migraineurs”) have this type. For those who do not, their condition is known by professionals as “common migraine.” Even without aura, you may experience light sensitivity, nausea, and other symptoms.

Gabapentin for the Prophylaxis of Episodic Migraine in Adults

Am Fam Physician. 2014 May 1;89(9):714-715.

Author disclosure: No relevant financial affiliations.

Clinical Question

Does gabapentin (Neurontin) help prevent episodic migraine?

Evidence-Based Answer

Gabapentin does not decrease the frequency of migraine headaches and is not recommended for prophylactic therapy. (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Worldwide, migraine has a lifetime prevalence of 18% in women and 10% in men.1 Therapeutic options are usually divided into prophylactic and abortive. Avoidance of triggers may be beneficial. Effective prophylaxis can range from acupuncture to medications such as propranolol, topiramate (Topamax), and valproic acid (Depakene), all of which have shown consistent positive benefit in systematic reviews.25

Previously published systematic reviews by these same authors gave cautious support for the use of gabapentin for migraine prophylaxis based on poor-quality evidence. However, new data from not-yet-published industry-sponsored trials of gabapentin for migraine have come to light during litigation against the drug manufacturer. These data have led the authors to change their conclusion based on the results of five studies involving 1,009 patients.

Four trials with a total of 351 patients compared gabapentin in a dosage of 900 to 2,400 mg per day with placebo. The meta-analysis found no significant reduction in the frequency of migraine headache (mean difference in the number of headaches = −0.44; 95% confidence interval, −1.43 to 0.56). Pooled results of two studies with 235 patients comparing the proportion of responders (at least 50% improvement in frequency of headaches) between those treated with up to 2,400 mg of gabapentin vs. placebo failed to show a difference (odds ratio = 1.59; 95% confidence interval, 0.57 to 4.46). One study analyzed prophylactic use of the prodrug gabapentin enacarbil (Horizant) titrated up to 3,000 mg daily and failed to find any benefit.

Patients taking gabapentin often reported adverse effects, most commonly dizziness (number needed to harm [NNH] = 7), drowsiness (NNH = 9), and abnormal thinking (NNH = 20).

According to the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society, prophylaxis should be offered to anyone whose daily activities are severely impaired, or when acute drug treatment is inadequate. The antiepileptic drugs topiramate and valproic acid are considered first-line prophylactic agents. However, the guidelines state that the evidence is inadequate to recommend the use of gabapentin for migraine prevention.6 Because gabapentin is not effective and commonly causes adverse effects, family physicians should consider alternatives when offering prophylaxis for migraine headache.

Author disclosure: No relevant financial affiliations.

 

What are the Causes of Headache and How to Treat Headache ?

When a bad headache strikes, you just want it to end. The aching, throbbing pain can be debilitating and result in missed appointments, work, or time with family and friends.

Your headache symptoms can help your doctor determine its cause and the appropriate treatment. Most headaches aren’t the result of a serious illness, but some may result from a life-threatening condition requiring emergency care.

Headaches are generally classified by cause:

Primary headaches

A primary headache is caused by overactivity of or problems with pain-sensitive structures in your head. A primary headache isn’t a symptom of an underlying disease.

Chemical activity in your brain, the nerves or blood vessels surrounding your skull, or the muscles of your head and neck (or some combination of these factors) can play a role in primary headaches. Some people may also carry genes that make them more likely to develop such headaches.

The most common primary headaches are:

  1. Cluster headache
  2. Migraine
  3. Migraine with aura
  4. Tension headache
  5. Trigeminal autonomic cephalalgia (TAC), such as cluster headache and paroxysmal hemicrania

A few headache patterns also are generally considered types of primary headache, but are less common. These headaches have distinct features, such as an unusual duration or pain associated with a certain activity.

Although generally considered primary, each could be a symptom of an underlying disease. They include:

  1. Chronic daily headaches (for example, chronic migraine, chronic tension-type headache, or hemicranias continua)
  2. Cough headaches
  3. Exercise headaches
  4. Sex headaches

Some primary headaches can be triggered by lifestyle factors, including:

  1. Alcohol, particularly red wine
  2. Certain foods, such as processed meats that contain nitrates
  3. Changes in sleep or lack of sleep
  4. Poor posture
  5. Skipped meals
  6. Stress

Secondary headaches

A secondary headache is a symptom of a disease that can activate the pain-sensitive nerves of the head. Any number of conditions — varying greatly in severity — may cause secondary headaches.

Possible causes of secondary headaches include:

  1. Acute sinusitis (nasal and sinus infection)
  2. Arterial tears (carotid or vertebral dissections)
  3. Blood clot (venous thrombosis) within the brain — separate from stroke
  4. Brain aneurysm (a bulge in an artery in your brain)
  5. Brain AVM (arteriovenous malformation) (arteriovenous malformation) — an abnormal formation of brain blood vessels
  6. Brain tumor
  7. Carbon monoxide poisoning
  8. Chiari malformation (structural problem at the base of your skull)
  9. Concussion
  10. Coronavirus disease 2019 (COVID-19)
  11. Dehydration
  12. Dental problems
  13. Ear infection (middle ear)
  14. Encephalitis (brain inflammation)
  15. Giant cell arteritis (inflammation of the lining of the arteries)
  16. Glaucoma (acute angle closure glaucoma)
  17. Hangovers
  18. High blood pressure (hypertension)
  19. Influenza (flu) and other febrile (fever) illnesses
  20. Intracranial hematoma
  21. Medications to treat other disorders
  22. Meningitis
  23. Monosodium glutamate (MSG)
  24. Overuse of pain medication
  25. Panic attacks and panic disorder
  26. Persistent post-concussive symptoms (Post-concussion syndrome)
  27. Pressure from tight headgear, such as a helmet or goggles
  28. Pseudotumor cerebri
  29. Stroke
  30. Toxoplasmosis
  31. Trigeminal neuralgia (as well as other neuralgias, all involving irritation of certain nerves connecting the face and brain)

Some types of secondary headaches include:

  1. External compression headaches (a result of pressure-causing headgear)
  2. Ice cream headaches (commonly called brain freeze)
  3. Medication overuse headaches (caused by overuse of pain medication)
  4. Sinus headaches (caused by inflammation and congestion in sinus cavities)
  5. Spinal headaches (caused by low pressure or volume of cerebrospinal fluid, possibly the result of spontaneous cerebrospinal fluid leak, spinal tap or spinal anesthesia)
  6. Thunderclap headaches (a group of disorders that involves sudden, severe headaches with multiple causes)

Regardless of whether you are prone to migraines, tension headaches, or cluster headaches (see “Is this your headache?”), you may be able to reduce their frequency by identifying what brings them on. Here’s a look at the most common triggers for each of these kinds of headaches.

1. Stress. Stress can cause tight muscles in the shoulders and neck, which often leads to tension headaches. “It’s believed to start in the muscles. When tension headaches become frequent, the pain in shoulder and neck muscles is felt by the brain as pain in the head,” says Dr. Sait Ashina, a neurologist who specializes in headache treatment at Harvard-affiliated Beth Israel Deaconess Medical Center. Stress is also a common trigger for migraines.

2. Diet. Hunger itself can trigger a migraine or tension headache. But eating certain foods may trigger migraines. It could be just one type of food — like beans or nuts — or many foods, such as avocados, bananas, cheese, chocolate, citrus, herring, dairy products, and onions. “Processed foods with nitrites, nitrates, yellow food dyes, or monosodium glutamate can be especially problematic,” Dr. Ashina notes.

3. Alcohol intake. Alcohol is a common cause of migraine and cluster headaches. For some people, a few ounces of red wine are all it takes to provoke a headache, although any kind of alcohol can be a trigger. It’s not clear if the alcohol itself is to blame or if another component in the drink causes the problem.

4. Environment. “Cluster headaches seem to be seasonal and often happen in the spring or fall,” Dr. Ashina says. “It’s something in the environment, but we can’t tell exactly what it is yet.” Environmental factors such as bright light, smoke, humidity, intense scents, or cold weather are associated with migraine headaches.

5. Hormones. Changes in estrogen levels are associated with migraines in women, and women suffer from migraines more often than men. Menstrual cycles may be tied to migraine in younger women. Varying estrogen levels during perimenopause can sometimes start migraines in women who never experienced them before. Estrogen therapy may also be a migraine trigger. Menopause does seem to end migraines in most women.

6. Caffeine withdrawal. If you normally consume caffeine in coffee or tea, stopping intake abruptly may trigger a migraine. This may be because caffeine causes blood vessels to constrict; without caffeine, the blood vessels widen and bulge out with each heartbeat — a chief reason for the pounding pain of migraines.

7. Lack of sleep. A lack of sleep is associated with migraines and tension headaches. “We don’t know why, but we do know there’s a correlation and that sleep can lead to pain relief. Sometimes people feel better after taking a nap,” Dr. Ashina says.

How to Treat Headaches ?

Your head hurts. Again. The first step in foiling your frequent headaches is determining what type of headache you have. Sometimes headaches are a symptom of another disease or condition; sometimes there’s no clear cause.

Take a close look at your headache signs and symptoms. Keeping a headache diary might help determine your headache type. Note when your headaches occur, your symptoms, and potential triggers, such as food, stress or changes in sleep.

There are many types and sub-types of headaches. Chronic daily headaches, which occur 15 days or more a month, are one sub-type. Tension-type headaches and migraines are also common sub-types of headaches. They can both be chronic, though they aren’t always. Other types of chronic daily headaches include:

  • Hemicrania continua, a one-sided headache that can feel like a migraine
  • Primary stabbing headaches, which last for a few seconds and can occur several times throughout the day
  • Primary exertional headaches, caused by exercise
  • Chronic paroxysmal hemicranias, sharp, one-sided headaches that can cause tearing or a congested nose
  • Medication overuse headaches, which occur from overusing pain medications for headaches for at least three months. These headaches occur at least 15 days out of the month.

Other headache types include:

  • Cluster headaches, which cause severe pain on one side of the head and occur off and on for weeks over the course of a few months. Cluster headaches are associated with one or more signs and symptoms, such as tearing, nasal congestion and nasal discharge. These occur on the same side as the pain.

Tension-type headaches

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Tension-type headaches, the most common variety of headaches:

    • Might be felt as a tight band of pain around your head, a dull ache or pressure
    • Might cause mild to moderate pain on both sides of the head
    • Vary widely in frequency
      • Can be occasional
      • May occur more than 15 days a month (chronic)
  • Last from 30 minutes to a week

Headache Treatment

Most occasional tension-type headaches are easily treated with over-the-counter medications, including:

  • Aspirin
  • Ibuprofen (Advil, Motrin IB, others)
  • Acetaminophen (Tylenol, others)
  • Fioricet

Daily prescription medications, including tricyclic antidepressants, might manage chronic tension-type headaches. Alternative therapies aimed at stress reduction might help. They include:

  • Cognitive behavioral therapy
  • Biofeedback
  • Massage therapy
  • Acupuncture

Migraines

Migraines are another common type of headache. They affect three times more women than men. Migraines typically:

  • Cause pain that is moderate to severe
  • Pulsate
  • Cause nausea, vomiting, or increased sensitivity to light or sound
  • Affect only one side of your head, but can affect both sides
  • Worsen with activity such as climbing steps
  • Last from four to 72 hours without treatment

Treatment

Migraine treatment is aimed at relieving symptoms and preventing additional attacks. If you know what triggers your migraines, avoiding those triggers and learning how to manage them can help prevent migraines or lessen the pain. Treatment might include:

  • Rest in a quiet, dark room
  • Hot or cold compresses to your head or neck
  • Massage and small amounts of caffeine
  • Over-the-counter medications such as ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others) and aspirin
  • Prescription medications including triptans, such as sumatriptan (Imitrex) and zolmitriptan (Zomig)
  • Preventive medications such as metoprolol (Lopressor), propranolol (Innopran, Inderal, others), amitriptyline, divalproex (Depakote), topiramate (Qudexy XR, Trokendi XR ,Topamax) or erenumab-aooe (Aimovig)

Recognize emergency symptoms

Seek emergency care if you have:

  • A very severe, sudden headache
  • Headache after a head injury or fall
  • Fever, stiff neck, rash, confusion, seizure, double vision, weakness, numbness or difficulty speaking
  • Pain that worsens despite treatment

These symptoms suggest a more serious condition, so it’s important to get a prompt diagnosis and treatment.

Take control

Almost everyone gets headaches, and many are nothing to worry about. But if headaches are disrupting your activities, work or personal life, it’s time to see your doctor. Headaches can’t always be prevented, but your doctor can help you manage the symptoms.

Gabapentin for Migraine Prevention

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.

Off-label Gabapentin drug use for Migraine

Using a drug off-label means that a drug has been approved by the FDA for one purpose, and it’s being used for a different purpose that hasn’t been approved. A doctor can still prescribe it for this purpose because the FDA regulates the testing and approval of drugs, not how doctors use them to treat their patients. Your doctor can prescribe a drug off-label if they think it’s best for your care.

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.img-banner - blankpixel_rickett_hl_middle_2854

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.

 

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.