Neurontin is the trade name for the generic drug gabapentin. It is useful as an anti-epileptic drug and as an analgesic, particularly for pain of the neuropathic or neurogenic type. (pain from irritation or inflammation of nerves). When used for controlling epilepsy, it is usually used in conjunction with another anti-epileptic drug. It is used much more extensively in the medical field to treat pain than it is to treat epilepsy.
The chemical structure of gabapentin is related that of gamma-aminobutyric acid (GABA) which is a neurotransmitter in the brain. The exact mechanism as to how gabapentin controls epilepsy and relieves pain is unknown, but it probably acts like the neurotransmitter GABA.
Animal studies show that gabapentin prevents the development of allodynia (a normally non painful stimulus which is perceived as painful) and hyperalgesia (an exaggerated response to a painful stimulus).
Gabapentin can be very helpful in controlling the pain of trigeminal neuralgia (tic doloreaux), post herpetic neuralgia (the lingering pain after a bout of shingles), the pain of diabetic neuropathy and other neuritic pains such as pain from nerve irritation due spinal arthritis or disc disease and occipital neuralgia. Occasionally it seems to be helpful in controlling migraine and other headaches. It has also been reported to be helpful in controlling the pain of fibromyalgia.
International and domestic studies that have evaluated Neurontin for migraine prevention suggest that it is effective. In a study of 63 patients with migraine (with or without aura), gabapentin significantly reduced migraine frequency and intensity among 30 patients who received it. In this study, adverse events were mild to moderate in severity.
Similarly, in a large study, 143 people with migraine received daily doses of Neurontin or placebo for 12 weeks. At the end of 12 weeks, the migraine rate had declined from 4.2 migraines before treatment to 2.7 migraines after treatment in those who received this drug.
This decrease was significantly greater than the decrease from 4.1 migraines to 3.5 migraines among those who received placebo. Of the 56 gabapentin recipients, 46% had at least a 50% reduction in the four-week migraine rate. Drug-related adverse events (sleepiness and dizziness) led to drug withdrawal in 13% of patients in the gabapentin group compared with 7% in the placebo group. The researchers concluded that this medication is an effective and well-tolerated preventive for migraine.
Gabapentin is an effective prophylactic agent for patients with migraine. In addition, gabapentin appears generally well tolerated with mild to moderate somnolence and dizziness.
How are migraines treated?
Migraine headaches are chronic. They can’t be cured, but they can be managed and possibly improved. There are two main treatment approaches that use medications: abortive and preventive.
- Abortive medications are most effective when you use them at the first sign of a migraine. Take them while the pain is mild. By possibly stopping the headache process, abortive medications help stop or decrease your migraine symptoms, including pain, nausea, light sensitivity, etc. Some abortive medications work by constricting your blood vessels, bringing them back to normal and relieving the throbbing pain.
- Preventive (prophylactic) medications may be prescribed when your headaches are severe, occur more than four times a month and are significantly interfering with your normal activities. Preventive medications reduce the frequency and severity of the headaches. Medications are generally taken on a regular, daily basis to help prevent migraines.
What medications are used to relieve migraine pain?
Over-the-counter medications are effective for some people with mild to moderate migraines. The main ingredients in pain relieving medications are ibuprofen, aspirin, acetaminophen, naproxen and caffeine.
Three over-the-counter products approved by the Food and Drug Administration for migraine headaches are:
- Excedrin® Migraine.
- Advil® Migraine.
- Motrin® Migraine Pain.
Be cautious when taking over-the-counter pain relieving medications. Sometimes overusing them can cause analgesic-rebound headaches or a dependency problem. If you’re taking any over-the-counter pain medications more than two to three times a week, report that to your healthcare provider. They may suggest prescription medications that may be more effective.
Prescription drugs for migraine headaches include:
Triptan class of drugs (these are abortives):
- Sumatriptan.
- Zolmitriptan.
- Naratriptan.
Calcium channel blockers:
- Verapamil.
Calcitonin gene-related (CGRP) monoclonal antibodies:
- Erenumab.
- Fremanezumab.
- Galcanezumab.
- Eptinezumab.
Beta blockers:
- Atenolol.
- Propranolol.
- Nadolol.
Butalbital:
- Generic Fioricet
- Fioricet Online
Antidepressants:
- Amitriptyline.
- Nortriptyline.
- Zanaflex
- Doxepin.
- Venlafaxine.
- Duloxetine.
- Flexeril
- Robaxin
Antiseizure drugs:
- Valproic acid.
- Topiramate.
- Gabapentin (Neurontin )
Other:
- Steroids.
- Phenothiazines.
- Corticosteroids.
Your healthcare provider might recommend vitamins, minerals, or herbs, including:
- Riboflavin (vitamin B2).
- Magnesium.
- Feverfew.
- Butterbur.
- Co-enzyme Q10.
Drugs to relieve migraine pain come in a variety of formulations including pills, tablets, injections, suppositories and nasal sprays. You and your healthcare provider will discuss the specific medication, combination of medications and formulations to best meet your unique headache pain.
Drugs to relieve nausea are also prescribed, if needed.
All medications should be used under the direction of a headache specialist or healthcare provider familiar with migraine therapy. As with any medication, it’s important to carefully follow the label instructions and your healthcare provider’s advice.
Alternative migraine management methods, also known as home remedies, include:
- Resting in a dark, quiet, cool room.
- Applying a cold compress or washcloth to your forehead or behind your neck. (Some people prefer heat.)
- Massaging your scalp.
- Yoga.
- Applying pressure to your temples in a circular motion.
- Keeping yourself in a calm state. Meditating.
- Biofeedback.