Gabapentin (Neurontin®) for Migraine & Headache

Based on "Headache and Migraine Biology and Management"
edited by Seymour Diamond, MD

Despite the conflicting data arising from clinical studies, considerable evidence suggests that gabapentin has benefits in the treatment of headaches, including migraine headaches.

Headaches

Gabapentin is quite effective in the treatment of cluster and chronic daily headaches. Most people achieve the reduction of headache frequency within 1-2 weeks4-5.


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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 mg4. 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 months6.

Gabapentin may be useful for refractory cases of hemicrania continua, a chronic and persistent form of unilateral headache 12.

Migraines

Gabapentin is used "off-label" for migraine prevention and treatment, including migraines with or without aura, vestibular migraines. It reduces the frequency of headaches, pain intensity, and the use of symptomatic medications1, 2. However, gabapentin is not helpful for migraine aura, vertigo, or other accompaing symptoms. Gabapentin is a good preventive therapy for migraines refractory to standard medications3.

Current Canadian Headache Society guideline for migraine prophylaxis9 rate gabapentin as strongly recommended prophylactic treatment with moderate quality evidence.

Clinical trials

The double-blind study1 of 143 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.

Randomized, double-blind, placebo-controlled clinical study10 of gabapentin enacarbil for migraine prophylaxis concluded that gabapentin was not significantly superior to placebo for migraine prophylaxis.

Mechanism of migraine prophylaxis

Experimental research11 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.

Note: 2013 Cochrane review concluded that "gabapentine is not efficacious for the prophylaxis of episodic migraine in adults" 7.

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Further reading

References

  • 1. Mathew NT, Rapoport A, Saper J, Magnus L, Klapper J, Ramadan N, Stacey B, Tepper S. Efficacy of gabapentin in migraine prophylaxis. Headache. 2001 Feb;41(2):119-28. PubMed
  • 2. Di Trapani G, Mei D, Marra C, Mazza S, Capuano A. Gabapentin in the prophylaxis of migraine: a double-blind randomized placebo-controlled study. Clin Ter. 2000 May-Jun;151(3):145-8. PubMed
  • 3. Vukovic V, Lovrencic-Huzjan A, Bosnar-Puretic M, Demarin V. Acta Clin Croat. 2009 Jun;48(2):145-51.
  • 4. Leandri M, Luzzani M, Cruccu G, Gottlieb A. Drug-resistant cluster headache responding to gabapentin: a pilot study. Cephalalgia. 2001 Sep;21(7):744-6. PubMed
  • 5. Spira PJ, Beran RG. Gabapentin in the prophylaxis of chronic daily headache: a randomized, placebo-controlled study. Neurology. 2003 Dec 23;61(12):1753-9. PubMed
  • 6. Schuh-Hofer S, Israel H, Neeb L, Reuter U, Arnold G. Eur J Neurol. 2007 Jun;14(6):694-6.
  • 7. Linde M, Mulleners WM, Chronicle EP, McCrory DC. Gabapentin for the prophylaxis of episodic migraine in adults. Cochrane Database Syst Rev. 2013 Jun 24;6. PubMed
  • 8. Jafarian S, Abolfazli R, Gorouhi F, Rezaie S, Lotfi J. Gabapentin for prevention of hypobaric hypoxia-induced headache: randomized double-blind clinical trial. J Neurol Neurosurg Psychiatry. 2008 Mar;79(3):321-3. PubMed
  • 9. Canadian Headache Society guideline for migraine prophylaxis. National Guideline Clearinghouse
  • 10. Silberstein S, Goode-Sellers S, Twomey C, Saiers J, Ascher J. Randomized, double-blind, placebo-controlled, phase II trial of gabapentin enacarbil for migraine prophylaxis. Cephalalgia. 2013 Jan;33(2):101-11. PubMed
  • 11. Zhang Y, Shao G, Zhang W., et al. Gabapentin inhibits central sensitization during migraine. Neural Regen Res. 2013 Nov 15;8(32):3003-12. PubMed
  • 12. Pareja JA, Alvarez M. The usual treatment of trigeminal autonomic cephalalgias. Headache. 2013 Oct;53(9):1401-14. PubMed

Published: September 08, 2012
Last reviewed: July 14, 2017

Interesting facts
  • Migraine and epilepsy share several features and respond to many of the same medicines, suggesting that similar mechanisms may be involved in their pathophysiology.
  • Gabapentin is useful for prevention of high-altitude headache 8.
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