Anticonvulsants in migraine prophylaxis: a Cochrane review


  • This paper is adapted from a systematic Cochrane review, accessible in The Cochrane Library through: Chronicle EP, Mulleners WM. Anticonvulsant drugs for migraine prophylaxis. Cochrane Database of Systematic Reviews 2004; Issue 3. Art. no. CD003226. DOI: 10.1002/14651858.CD003226.pub2.

Dr Wim M. Mulleners, Department of Neurology, Canisius Wilhelmina Ziekenhuis, PO Box 9015, Nijmegen 6500 GS, the Netherlands. Tel. + 31 2 4365 7657 or + 31 2 4365 8765, fax + 31 2 4365 7329, e-mail


Several trials have asserted that some anticonvulsant drugs seem to be useful for the prophylaxis of migraine, but systematic reviews are sparse. We independently searched PubMed, EMBASE and the Cochrane Central Register of Controlled Trials until 2005, as well as Headache and Cephalalgia through April 2006, for prospective, controlled trials of anticonvulsant drugs. Data were calculated and pooled across studies and expressed as standardized mean differences, odds ratios and numbers-needed-to-treat. Anticonvulsants, considered as a class, reduce migraine frequency by about 1.3 attacks per 28 days compared with placebo, and more than double the number of patients for whom migraine frequency is reduced by ≥ 50% relative to placebo. Sodium valproate/divalproex sodium and topiramate were better than placebo, whereas acetazolamide, clonazepam, lamotrigine and vigabatrin were not; gabapentin, in particular, needs further evaluation. Trials designed with sufficient power to compare different drugs are also necessary.