A new review indicates that gabapentin may be an effective adjunct therapy for primary headache syndromes, but that there is not enough evidence to support its use as a primary treatment. This study on the off-label use of gabapentin for headache disorders appears online in the in the journal Pain Medicine.

For the review, 56 articles were identified and eight clinical trials with quality of evidence Class 2 or higher based on American Academy of Neurology criteria. Seven showed statistically significant clinical benefit from gabapentin in various headache syndromes (although the effects were modest at times) and one study had concerning intention-treat analysis breaches and primary outcomes. The primary outcomes in the review included frequency and intensity of migraine attacks, percentage of headache-free days per months in chronic daily headache, and episode duration and intervals for cluster headache.

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It is believed that gabapentin may reduce the release of inflammatory neuropeptides implicated in headache pain, such as calcitonin gene-related peptide (CGRP) and substance P; it could also reduce the release of excitatory neurotransmitters such as glutamate. However, the authors concluded that there is not sufficient evidence to support it as primary therapy and that its use for headache syndromes should be evaluated on a case-by-case basis.

Gabapentin is indicated for the treatment of postherpetic neuralgia and as adjunct in partial seizures.

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