Levetiracetam for the Prophylaxis of Migraine in Adults

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 hyperexcitability. 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.

A potential role of mechano-gated potassium channels in meningioma-related seizures

“…The decreased expression results in the alleviation of severity and seizure frequency severity in chronic epilepsy animal model [ 21 ]. In addition to the use in epilepsy treatment, levetiracetam is applied as a prophylaxis for migraine [ 22 , 23 ]. Mechano-gated potassium channels are involved in migraine development [ 22 ], so the suppressing effects of levetiracetam against KCNK4 channel may be involved in the anti-migraine effects as well [ 24 ].…”

“…In addition to the use in epilepsy treatment, levetiracetam is applied as a prophylaxis for migraine [ 22 , 23 ]. Mechano-gated potassium channels are involved in migraine development [ 22 ], so the suppressing effects of levetiracetam against KCNK4 channel may be involved in the anti-migraine effects as well [ 24 ]. Finally, it is important to point out that no significant changes in the level of KCNQ2 were observed for any of the analyzed parameters.…”

Long-Term Management of Migraine With OnabotulinumtoxinA (Botox) vs Calcitonin Gene-Related Peptide Antibodies (Anti-CGRP)

“…To create a liquid solution, the medication is blended. The drug is administered intramuscularly to individuals with persistent migraine headaches in order to avoid migraines and injected into various parts (shown in Figure 3 below) [22]. Drugs used as preventative measures are meant to lessen the frequency of migraine attacks [22].…”