Levetiracetam for the Prophylaxis of Migraine in Adults.

Gauhar M Azeem,Abdul Rehman,Filzah Faheem,Danish Sohail,Nimrah Farooq,Muhammad Usama Javed

doi:10.7759/cureus.16779

Abstract

Migraine is the second most common primary headache disorder after tension-type headache and is the leading cause of disability worldwide. Cortical spreading depression involves neuronal excitation and inhibition and is involved in pathophysiology of migraine. Many anti-epileptic drugs act by inhibiting Cortical Spreading Depression and block desensitization. Anti-convulsants are commonly used in Migraine prophylaxis and the ones being more effective than placebo include Sodium Valproate and Topiramate. Levetiracetam has unique mechanism as it targets hyper-excitable neurons by binding to synaptic vesicle protein. This results in inhibition of neurotransmitter release thus decreases hyper-excitability. Levetiracetam has minimal side effect profile (dizziness, somnolence and mood changes) and it can be well tolerated by patients. In this review, a total of seven studies were included (four open-label trials and three randomized-control trials) which evaluated the role of Levetiracetam in the prophylaxis of migraine in adult patients. On review of this evidence, Levetiracetam appears to be effective in treating migraine with and without aura and is considered safe because of its limited side effects. There was a significant reduction in the frequency, severity, and duration of migraine with a high responder rate. Levetiracetam was well tolerated with minimal side effects and no reported interactions. However, larger randomized controlled trials are needed and these studies should be done on special population to see the outcomes. In addition, studies for extended-release formulations should also be done.

Highlights

BackgroundMigraine is the second most common primary headache disorder after tension-type headache and is the leading cause of disability worldwide [1]
PubMed showed 78 results concerning our question, all the results were read in detail and out of these results we found three randomized controlled trials and three open-label studies contained direct evidence pertaining to our question and they were included in the review
A review study done by Li et al in 2018 included 25 patients, out of which 11 either did not follow up or dropout, so, patients (12 females and two males) with migraine between and 60 years of age who satisfied the International Classification of Headache Disorders, 3rd edition (ICHD-III) criteria completed the study

Summary

Introduction

BackgroundMigraine is the second most common primary headache disorder after tension-type headache and is the leading cause of disability worldwide [1]. The most common types of migraine include migraine without aura (66%) and Migraine with aura (33%) [2]. It is a highly prevalent headache disorder affecting about 37 million people in the United States and one billion people worldwide [3]. In adults Migraine is three times more prevalent in females than males, being more prevalent in 20-40 years of age [5,6]. A cross-sectional prevalence survey conducted in Pakistan revealed the overall prevalence of migraine to be 22.9% most common in 40-49 age group (20.6% in males and 38.3% in females) [7]

Results

Discussion

Conclusion