Study conclusions: "Overall, oxcarbazepine was safe and well tolerated; however, oxcarbazepine did not show efficacy in the prophylactic treatment of migraine headaches."
“The results of this trial do not support preliminary data which had suggested oxcarbazepine was effective in preventing migraine... While several epilepsy drugs have been used for decades to prevent migraine, oxcarbazepine did not prevent migraine in this study despite it being shown to be safe and well-tolerated.”
~study author Stephen D. Silberstein, MD
Director, Jefferson Headache Center, Thomas Jefferson University, Philadelphia
Fellow of the American Academy of Neurology
According to Silberstein, the three neuronal stabilizing agents that most effectively prevent Migraine are topiramate (Topamax), divalproex (Depakote), and gabapentin (Neurontin). These three medications impact Migaine through several mechanisms, including the ability to regulate a neurotransmitter known as GABA. Oxcarbazepine, however, has no apparent activity on GABA. Silberstein says it’s possible that these drugs must be able to regulate this neurotransmitter in order to prevent Migraine.
In addition, Silberstein says several factors may have contributed to the lack of response in this study, including that the participants had difficult-to-treat Migraines.
The study was supported by Novartis Pharmaceuticals Corporation, the manufacturer of oxcarbazepine.
Summary and comments
Although good results have been seen with several neuronal stabilzing agents including Topamax, Depakote, Neurontin, Zonegran, and others, this study shows that Trileptal is not helpful for Migraine prevention. It's worth noting that this study was funded by the manufacturer of Trileptal, Novartis.
We more often see studies that show positive results. However, as Dr. Silberstein commented, "It is just as important to print negative as well as positive trials."
At this time, there is no medication on the market that was developed for Migraine prevention. What we have is "hand-me-down" medications originally developed for other conditions. One reason for this is lack of NIH funding for basic Migraine and headache research. Hopefully, this will change, and we will start to see more effective preventive treatments.
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Resources:
Silberstein, S., MD; Saper, J., MD; Berenson, F., MD; Somogyi, M., MD; McCague, K., MA; D'Souza, J., PhD. "Oxycarbazepine in migraine headache." Neurology 2008;70:548-555.
Personal Interview. Dr. Stephen D. Silberstein, Teri Robert. February 11, 2008.
Press Release. "Drug Doesn’t Help Prevent Migraine After All." American Academy of Neurology. St. Paul. February 11, 2008.
© Teri Robert, 2008.
Last updated February 11, 2008.
