Antiepileptic Treatment Shows Efficacy in Reducing Migraine Frequency

Each study found significant decreases in headache frequency with levetiracetam compared to baseline or placebo.
Each study found significant decreases in headache frequency with levetiracetam compared to baseline or placebo.

The antiepileptic drug levetiracetam may represent an effective prophylactic treatment option for episodic migraine, according to a systematic review published in the Journal of Clinical Pharmacy and Therapeutics. Insufficient evidence is available to determine the drug's efficacy as a chronic migraine prophylactic.

Studies reviewed included 2 retrospective chart reviews, 4 randomized controlled trials, and 5 prospective open-label studies examining the safety and efficacy of levetiracetam in patients with chronic or episodic migraine. Only 2 double-blind studies compared levetiracetam treatment with an active antiepileptic drug (valproate sodium) and another 2 compared levetiracetam with placebo. The doses of levetiracetam across the 11 studies (n=441 patients) ranged from 125mg to 2000mg/day for a period of 6 to 24 weeks.

An open-label trial of pediatric patients with episodic migraine indicated that levetiracetam treatment resulted in a reduction in mean monthly headache frequency from baseline to 2-month follow-up (6 vs 2 migraines/month, respectively; P<.001). Another study examining the efficacy of the drug in adult patients with episodic migraine also reported reductions in mean headache frequency at months 1, 2, and 3 months from baseline (3.3, 3.6, 2.8, and 8.1 headaches/month, respectively; P<.001). 

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In a study of elderly patients with episodic migraine, 1000 mg/day levetiracetam treatment led to a reduced monthly migraine frequency at 3 and 6 months compared with baseline levels (baseline: 12.2 migraines/month, 3 months: 4.1 migraines/month, 1.3 migraines/month; P<.0001 for both). Across all studies, 57.9% to 100% of participants experienced ≥50% reduction in headache frequency from baseline to individual study follow-up. In all studies examined, a decrease in the number of headaches per month was found and ranged from a reduction of 2.96 to 10.9 across studies. Somnolence, dizziness, and behavioral issues (eg, irritability, moodiness, hyperactivity, etc) were common transient effects associated with the treatment. 

A potential limitation of this review is the inclusion of studies with relatively small samples and/or an open-label design, which may have increased the risk for response bias. 

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“Levetiracetam appears to be well-tolerated and may be a relatively safe and effective alternative treatment option for episodic migraine prophylaxis in adults who are unable to tolerate or who have failed [to respond to] previous therapies,” concluded the study authors.

Reference

Watkins AK, Gee ME, Brown JN. Efficacy and safety of levetiracetam for migraine prophylaxis: A systematic review. [published online May 20, 2018]. J Clin Pharm Ther. doi:10.1111/jcpt.12715.