The antiepileptic drug levetiracetam may represent an effective prophylactic treatment option for episodic migraine, according to a systematic review published in the Journal of Clinical Pharmacy and Therapeutics. Insufficient evidence is available to determine the drug’s efficacy as a chronic migraine prophylactic.

Studies reviewed included 2 retrospective chart reviews, 4 randomized controlled trials, and 5 prospective open-label studies examining the safety and efficacy of levetiracetam in patients with chronic or episodic migraine. Only 2 double-blind studies compared levetiracetam treatment with an active antiepileptic drug (valproate sodium) and another 2 compared levetiracetam with placebo. The doses of levetiracetam across the 11 studies (n=441 patients) ranged from 125 mg to 2000 mg/day for a period of 6 to 24 weeks.

An open-label trial of pediatric patients with episodic migraine indicated that levetiracetam treatment resulted in a reduction in mean monthly headache frequency from baseline to 2-month follow-up (6 vs 2 migraines/month, respectively; P <.001). Another study examining the efficacy of the drug in adult patients with episodic migraine also reported reductions in mean headache frequency at months 1, 2, and 3 months from baseline (3.3, 3.6, 2.8, and 8.1 headaches/month, respectively; P <.001).

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In a study of elderly patients with episodic migraine, 1000 mg/day levetiracetam treatment led to a reduced monthly migraine frequency at 3 and 6 months compared with baseline levels (baseline: 12.2 migraines/month, 3 months: 4.1 migraines/month, 1.3 migraines/month; P <.0001 for both). Across all studies, 57.9% to 100% of participants experienced ≥50% reduction in headache frequency from baseline to individual study follow-up. In all studies examined, a decrease in the number of headaches per month was found and ranged from a reduction of 2.96 to 10.9 across studies. Somnolence, dizziness, and behavioral issues (eg, irritability, moodiness, hyperactivity, etc) were common transient effects associated with the treatment.

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A potential limitation of this review is the inclusion of studies with relatively small samples and/or an open-label design, which may have increased the risk for response bias.

“[L]evetiracetam appears to be well-tolerated and may be a relatively safe and effective alternative treatment option for episodic migraine prophylaxis in adults who are unable to tolerate or who have failed [to respond to] previous therapies,” concluded the study authors.

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Watkins AK, Gee ME, Brown JN. Efficacy and safety of levetiracetam for migraine prophylaxis: A systematic review. [published online May 20, 2018]. J Clin Pharm Ther. doi:10.1111/jcpt.12715