Elderly Patients with Migraine: An Open-Label Study on Prophylaxis Therapy with Levetiracetam

V.      Pizza; V.      Busillo; A.      Agresta; A.      Bisogno; A.      Capasso

Abstract

In the last years, the hypothesis that cortical hyperexcitability may play a role in the physiopatology of migraine led to the therapeutic use of some antiepileptic drugs. To evaluate the efficacy of levetiracetam as prophylactic treatment for migraine without aura in elderly patients. We performed a small open-label trial treating 13 elderly patients( 8F 5M) mean age 64.7 years (SD 3.4), range 60-72 years affected by migraine without aura (ICDH 04 criteria). The mean age of disease was 21.3 years (SD13.4) range 2-45 years. At baseline: the frequency of attacks was 12.2/month (SD 5.9), range 6-25; the mean number of drugs for acute attacks was 12.6 (SD 6.5) tablets/month. All patients took concomitant medication for other cronic diseases. After recruitment Levetiracetam 500 mg/die was administered for 1 week and 1000 mg/die for six months. The basal frequency of attack was 12,2 (SD 5.9) and 8,3 (SD 4.9), 4,1 (SD2.6), 1,3 (SD1.4) after 1, 3 and 6 months respectively [P=0.079; P < 0.0001; P < 0.0001].The basal value of intaking drugs for acute attacks was 12,6 (SD 6.5) and 6,7 (SD 4.3), 2,8 (SD 2.2), 1,4 (SD1.7) after 1, 3 and six months respectively [P=0.012; P < 0.0001; P < 0.0001](T-test analysis). Levetiracetam was well tolerated (7 patients complained somnolence, lack of concentration and gastralgia but none patient withdrew the study). In our study levetiracetam showed a good efficacy in frequency and intensity reduction of headache attack and showed a very good tolerability despite all elderly patients took drugs for concomitant diseases.

Keywords: Migraine, levetiracetam, prophylaxis therapy, antiepileptics drugs, Open-label study, headache attack, cerebral cortical hyperexcitability, pyrrolidine derivative, N-type voltage dependent calcium channels, comorbidities, elderly patients, efficacy, tolerability, pain, beta-blockers, Ca-antagonists, tricyclic antidepressants, membrane excitability, GABA, glutamate, nootropic, anxyiolitic, chronic diseases, hyperexcitability, intracortical