100 Migraine Drugs, A to Z: gabapentin

Gabapentin (Neurontin) is a drug that was originally developed for the treatment of epilepsy but now it is used for a wide variety of conditions except for epilepsy. It is just not strong enough to control epileptic seizures. Gabapentin can be effective for various pain syndromes, including the treatment of sciatic pain and it has an official FDA approval for the treatment of a very painful condition, postherpetic neuralgia, or shingles pain.

Several positive studies of gabapentin have been also reported for the treatment of episodic as well as chronic migraines. However, a review of all rigorous clinical trials of gabapentin for the treatment of migraine found no evidence that it really works. The authors of the review concluded that, “Since adverse events were common among the gabapentin-treated patients, it is advocated that gabapentin should not be used in routine clinical practice”. The adverse events were mostly dizziness and somnolence.

My personal experience also suggests that gabapentin is not highly effective and I do not use it “in routine clinical practice”. However, because gabapentin is proven to relieve other painful conditions and because it has a relatively benign side effect profile, I do use it in some patients with migraine, especially those with associated neck pain. It can also help patients with insomnia, although this indication is also not proven in large trials.

Gabapentin is used in doses of up to 3,600 mg a day and higher, although there have been reports of gabapentin abuse and dependence at doses above 3,000 mg a day. We usually start with 300 mg a day and slowly escalate the dose as needed and as tolerated to about 1,800 mg a day. Some patients report good relief of insomnia with 300 mg taken at night. Transition to menopause can be accompanied by temporary worsening of migriane headaches and gabapentin can also help menopausal hot flashes (and sleep) at a dose of 900 mg a day.