Other Anti-Seizure Drugs Under Investigation. These include Felbamate (Felbatol), Tiagabine (Gabitril), oxcarbazepine (Trileptal) and Zonisamide (Zonegran). Patients taking oxcarbazepine 300 mg/day for other medical conditions have reported a decrease in migraine frequency. Zonisamide has reduced migraine frequency in some clinical trials.
Side Effects. Anti-seizure medication's side effects vary by drug but may include:
- Nausea and vomiting
- Diarrhea
- Cramps
- Hair loss
- Dizziness
- Sleepiness
- Blurred vision
- Weight gain
- Valproate and divalproex can cause serious side effects of inflammation of the pancreas (pancreatitis) and damage to the liver
Tricyclic and Other Antidepressants
Certain antidepressants are quite effective in preventing all forms of headache, including migraine. The effects of any of these antidepressants on headaches are most likely due to their effects on serotonin, a chemical messenger in the brain that influences depression and migraine.
Tricyclics. Tricyclics are the most effective antidepressants for migraine prevention. They include amitriptyline (Elavil, Endep), nortriptyline (Pamelor, Aventyl), doxepin (Sinequan), and protriptyline (Vivactil). They are beneficial for patients who suffer from both depression and migraine, and may be particularly useful for patients who suffer from both migraines and tension headaches. Low doses may also help prevent cyclic vomiting in childhood migraine. They can have significant side effects, including disturbances in heart rhythms. They can also be fatal in overdose.
Other Antidepressants. Serotonin-reuptake inhibitors (SSRIs) include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and fluvoxamine (Luvox). SSRIs are sometimes helpful in reducing migraines, although in general their effects are disappointing.
Newer antidepressants target neurotransmitters, such as norepinephrine, alone or in addition to serotonin. Nefazodone (Serzone) and venlafaxine (Effexor) are such drugs that are showing some promise in preventing migraines.
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