Oxcarbazepine ineffective as prophylaxis for migraine
Oxcarbazepine is not an effective prophylactic treatment for migraine headache, a study reveals (Neurology 2008;70:548).
Researchers compared the drug with placebo in a trial involving 170 patients.
For the 85 patients randomised to oxcarbazepine, treatment was started
at 150mg per day and titrated upwards to a maximum dose of 1,200mg per
day.
During the last 28 days of treatment there was no difference in the mean
change in number of migraine attacks for patients given placebo and those
treated with oxcarbazepine. The researchers suggest that the lack of
response observed for oxcarbazepine, compared with effects seen for other
antiepilepsy drugs, may be due to differences in their mechanisms of
action.
“The three antiepilepsy drugs that most effectively prevent migraine — topiramate,
[valproate] and gabapentin — have multiple mechanisms of action,
including a modulatory effect on gamma-aminobutyric acid. … In
contrast, oxcarbazepine is a sodium channel blocker, calcium current
regulator,
and potassium channel function enhancer and has no apparent activity
on GABA regulation.
“It is possible that antiepilepsy drugs must be able
to modulate GABAergic transmission to prevent migraine,” they suggest. |
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