Anti-epileptic drug may reduce migraine aura
· Medical Xpressby Åsa Hansdotter, Lund University
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A new study by researchers at Lund University in Sweden found that 85% of patients with aura-dominant migraine experienced a reduction in monthly aura days by at least half following treatment with the anti-epileptic drug lamotrigine.
The findings, published in the journal Frontiers in Neurology, need to be confirmed in a controlled study, but could eventually be significant for a patient group that currently lacks a specific treatment for the aura itself.
Around 1.5 million people in Sweden suffer from migraine. Migraine limits the ability to work and participate in social activities, and leads to significant costs through sick leave, reduced productivity and increased health care needs. Women are three times as likely to be affected as often as men, a difference that is largely due to hormonal factors.
Up to a third of people with migraine experience aura—a temporary neurological symptom that can cause visual disturbances, loss of vision, sensory disturbances, balance problems, and speech and language difficulties, among other symptoms. For some patients, aura is the most debilitating symptom of the disease, but there is currently no established treatment that specifically targets it.
"Around 50,000 people in Sweden suffer from aura-dominant migraine. Aura is thought to be linked to cortical spreading depolarization (CSD), a slowly progressing wave of altered nerve cell activity in the cerebral cortex," says Gürdal Sahin, a researcher at Lund University and a specialist in neurology at the Skåneuro private clinic.
Migraine with aura is also associated with a slightly increased risk of ischemic stroke, particularly when combined with other vascular risk factors. It is therefore important to reduce modifiable risk factors.
"There are now several effective treatments for migraine, including new medications that block the neurotransmitter CGRP, which plays a key role in migraine attacks. Botulinum toxin is also used as a preventive treatment for chronic migraine. However, as there is no established treatment that specifically targets the aura itself, migraines with and without aura are often treated in a similar way, even though the aura appears to be partly based on mechanisms other than the headache itself," Sahin continues.
The medication lamotrigine is approved for the treatment of epilepsy and bipolar disorder, but not for migraine. However, because both epilepsy and migraine aura involve temporary changes in nerve cell activity, the researchers wanted to investigate whether the drug could also prevent aura.
Lamotrigine affects the electrical activity of nerve cells by acting on sodium and potassium channels. It also reduces the release of the neurotransmitter glutamate, among other things. In this way, the medication can reduce the excessive excitability of nerve cells. In theory, these mechanisms could help prevent the emergence and spread of CSD.
"In our study, we examined 81 patients with frequent or particularly troublesome migraine aura and treated them with lamotrigine. Among the patients included, the number of days with aura fell on average from 6.9 to 1.4 days per month, representing a reduction of around 80%," says Sena Uzun, a doctoral student at Lund University.
While previous studies involving lamotrigine have shown mixed results, this study's results were particularly promising for patients with aura-dominant migraine. In this group, 85% of patients experienced at least a 50% reduction in the number of days with aura. Another observation was that slower dose escalation was associated with fewer side effects, which may be relevant when the treatment is evaluated in future clinical trials.
"As the study is retrospective and lacks a control group, the results need to be confirmed. We are now proceeding with a national, randomized, double-blind, placebo-controlled trial of lamotrigine. If the results can be confirmed, the drug could become a relatively inexpensive and well-established treatment option for a group of patients who currently have no treatment for the aura itself," Uzun concludes.
Publication details
Sena Uzun et al, Lamotrigine prophylaxis is associated with reduced aura frequency in patients with burdensome migraine aura: a retrospective observational study, Frontiers in Neurology (2026). DOI: 10.3389/fneur.2026.1863747
Journal information: Frontiers in Neurology
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