Anticonvulsant drugs in primary headaches prophylaxis

Anticonvulsant drugs have been used in migraine prophylaxis since 1970. In recent years, new antiepileptic medications have given rise to much interest in pain control. Primary headaches prophylaxis is still base on old drugs, and physicians facing these conditions are always prompted to use any new possible choice. Among primary headaches, the most studied drug over last 15 years was divalproex sodium, and many papers showed its efficacy in the treatment of migraine headaches. Valproate is well tolerated and many dosages have been used with success. For the newer drugs, such as gabapentin, lamotrigine or topiramate, evidence is less strong but has been rapidly increasing in the last 5 years. In particular, topiramate has much more evidence of a good efficacy and a safe profile. We review the principal characteristics of their use, according to dosages, lasting of treatments, side effects and significant efficacy.