Is gabapentin an effective treatment choice for hemicrania continua?

Abstract

The objective of this study is to examine the efficacy of gabapentin for the treatment of hemicrania continua (HC) in cases where patients had difficulty tolerating indomethacin due to adverse effects. A retrospective chart review of nine patients with HC between October 2006 and February 2008. Inclusion criteria included men and women age 18 or above presenting to the headache center with a headache that meets International Headache Society criteria for HC including a response to indomethacin, but were not able to continue on indomethacin secondary to adverse effects. Four patients report being pain free, three patients report a 50–80% reduction of pain, one patient reports a 10% reduction of pain, and one patient reports no change in pain. Seven out of nine patients demonstrated at least a 50% reduction of pain on gabapentin, four patients becoming completely pain free.

Indomethacin-Responsive Headaches

“…Celecoxib and rofecoxib [74], melatonin [75,76], and gabapentin [77] have been reported as effective in small series of HC patients. Occipital nerve stimulation also appears to be a safe and effective treatment for HC [78].…”

Is there need to search for alternatives to indomethacin for hemicrania continua? Case reports and a review

“…We found at least 31 patients in the literature who showed complete and persistent effects by drugs other than indomethacin-cyclooxygenase-2 inhibitors, topiramate, piroxicam, melatonin, acetyl salicilic acid, ibuprofen, verapamil, and gabapentine (Table 1). Beside this, there are many case reports where above mentioned drugs and few other drugs (such as lamotrigine, methysegide, lithium carbonate, naproxen, paracetamol with caffeine) provided significant (although incomplete and/or transient) effect on the patients of HC [2,[6][7][8][9][10][15][16][17][18][19][20][21][22][23][24][25][26]. This observation is important.…”

Hemicrania Continua Responsive to Topiramate: Case Report

“…Considering the response reported in some cases, antiepileptic drugs like gabapentin, valproic acid and topiramate are interesting options in patients with HC with contraindications or intolerance to indomethacin. 9,5,10 Topiramate has multiple action mechanisms including voltage-sensitive sodium channel block, calcium channel inhibition, increase of potassium conductance, glutamate-mediated neurotransmission inhibition and carbonic anhydrase isoenzyme inhibition and has demonstrated antiepileptic activity. To date, it is not known which of these mechanisms of topiramate acts as a prophylactic treatment for various headache syndromes such as migraine, chronic tension-type headache, hypnic headache, chronic paroxysmal hemicrania and finally HC.…”