Bagnato Francesca, Good Janine
Department of Neurology, University of Maryland, Baltimore, MD, USA.
Department of Neurology, University of Vanderbilt, Nashville, TN, USA.
Headache. 2016 Mar;56(3):603-15. doi: 10.1111/head.12781. Epub 2016 Mar 3.
Migraine is a chronic debilitating disorder. Selected antiepileptic drugs (AEDs) are proposed as preventives for migraine. Clinical efficacy and side effects of these AEDs are discussed.
The American Academy of Neurology and the American Society of Headache classify topiramate (TPM) and divalproex sodium (DVPX) as Level-A medications and recommend offering them to patients for migraine prophylaxis. Their mechanism(s) of actions remains not entirely known. Their recognized action as sodium channel blockers may affect the neural component of migraine pain. TPM or DVPX can be considered an obvious choice for those patients with a concomitant seizure disorder. Care must be taken to plan their treatment with their psychiatrist if a mood disorder is present. DVPX tends not to be prescribed as first/second choice due to its potential for weight gain and hepatotoxicity. TPM is generally first choice, but bears severe contraindications. Both medications require education on teratogenesis in childbearing women. Consideration of gabapentin, acetazolamide, leviteracetam, zonisamide, and carbamazipine may be given later as empiric options and in selected patients. Patients must be made aware that there is insufficient scientific support for their use in migraine.
Available AEDs to prophylactically treat migraine are few but of robust clinical efficacy. Special care needs to be exerted with respect to their side effects. Future research is needed for a better understanding of their mechanisms of action in migraine. Such research has the potential of providing some insight into the pathophysiology of migraine.
偏头痛是一种慢性致残性疾病。某些抗癫痫药物（AEDs）被提议作为偏头痛的预防药物。本文讨论了这些AEDs的临床疗效和副作用。
美国神经病学学会和美国头痛协会将托吡酯（TPM）和丙戊酸钠（DVPX）列为A级药物，并建议将它们用于偏头痛的预防。其作用机制仍不完全清楚。它们作为钠通道阻滞剂的公认作用可能会影响偏头痛疼痛的神经成分。对于患有癫痫症的患者，TPM或DVPX可被视为明显的选择。如果存在情绪障碍，在与精神科医生共同规划治疗方案时必须谨慎。由于DVPX有体重增加和肝毒性的风险，通常不被作为首选/次选药物。TPM通常是首选，但有严重的禁忌症。两种药物都需要对育龄妇女进行致畸方面的教育。加巴喷丁、乙酰唑胺、左乙拉西坦、唑尼沙胺和卡马西平可作为经验性选择，在特定患者中稍后考虑使用。必须让患者知道，目前尚无足够的科学依据支持将它们用于偏头痛治疗。
可用于预防性治疗偏头痛的AEDs药物虽少，但临床疗效显著。在使用这些药物时，需要特别关注其副作用。未来需要进行更多研究，以更好地了解它们在偏头痛中的作用机制。这类研究有可能为偏头痛的病理生理学提供一些见解。
