When planning treatment strategies for epilepsy and migraine, the possibility of comorbid disease should be considered. Although tricyclic antidepressants and neuroleptic drugs are often used to treat migraine in patients with comorbid epilepsy, caution is advisable, as these medications may lower seizure thresholds.

When selecting drugs for migraine prophylaxis, it is sometimes advantageous to treat comorbid conditions with a single agent. For example, when migraine and hypertension occur concomitantly, a beta blocker or calcium channel blocker is often appropriate.36 In the same way, anticonvulsants with efficacy for both migraine and epilepsy (e.g., divalproex sodium, gabapentin, and topiramate) should be considered for patients with both disorders.

The anticonvulsant divalproex sodium (Depakote) is approved by the United States Food and Drug Administration (FDA) for migraine prophylaxis. Its efficacy has been supported by open and double-blind placebo-controlled studies.92–95 The doses that are effective in migraine (often 500 mg per day) are generally lower than those used for epilepsy.

Gabapentin, at a dose of 1800–2400 mg per day, has been shown to be superior to placebo for migraine.96

Topiramate, in both open and small placebo-controlled double-blind trials, has been shown to be effective for migraine at doses of 50–100 mg per day.97

Anticonvulsants can be administered to patients with depression, Raynaud’s disease, asthma, and diabetes, circumventing the contraindications to beta blockers.36

Adapted from: Silberstein, SD, and Lipton RB. Headache and epilepsy. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;239–254. 
With permission from Elsevier (www.elsevier.com). 

Reviewed By: 
Steven C. Schachter, MD
Thursday, April 1, 2004