Brain Hyperexcitability: The Basis for Antiepileptic Drugs in Migraine Prevention


  • K. Michael Welch MB, ChB, FRCP

  • From the Rosalind Franklin University of Medicine and Science, Department of Neurology, The Chicago Medical School, North Chicago, IL.

Address all correspondence to Dr. K. Michael Welch, Rosalind Franklin University of Medicine and Science, 3333 Greenbay Road, North Chicago, IL 60064.


Abnormal brain excitability may provide the susceptibility for triggering migraine attacks. Antiepileptic drugs may diminish neuronal excitability and consequently reduce the frequency of migraine. Because migraine aura is predominantly visual, hyperexcitability of the occipital cortex has been the focus of investigations. Functional magnetic resonance imaging of the brain and magnetoencephalography provide the most consistent evidence for the role of brain hyperexcitability in migraine and confirm that triggering an abnormal electric and metabolic event consistent with the cortical spreading depression (CSD) of Leao is anatomically and functionally linked with migraine aura symptoms. Future drug discovery should focus on the interface between the excitable cell and the earliest events of CSD.