Migraine Aura and Lamictal
Note: Lamictal studies on migraine to date have only shown Lamictal to be beneficial for those with migraine aura.
However, that being said other than this particular study there have been next to none that specifically study the response migraine with aura sufferers have to preventative drugs. There has barely even been research on whether or not there are treatment response difference between the two conditions.
And this is me on my soap box but: It is quite likely that many sufferers with migraine aura have a completely different mechanism than those with just migraine.
The Lamictal study muses on this some in the discussion section. Primarily on the theory that migraine with aura stems from Cortical Spreading Depression (CSD). The fact that migraine with aura sufferers respond, and those who do not get aura do not implies this. What is even more amazing with Lamictal is the response seems indiscriminate when it comes to the type of aura as the results showed a reduction in visual, hemiplegic, basilar, and other forms of complex aura.
The treatment outcomes were also mind blowingly positive 75% of those who took Lamictal had a significant reduction in migraine aura, and 77% of those who had a reduction in aura also had a significant reduction in migraine attacks. This kind of outcome is just unheard of. The study which had participants with hemiplegic, basilar, and complex aura still had a 68% response rate in terms of aura reduction. While the studies lack a control group, the response rates are still way higher than many of the controlled studies BEFORE placebo response is taken into account.
Also the proposed mechanism for how Lamictal fits in with Cortical Spreading Depression and migraine aura is very clear. Cortical Spreading Depression is essentially a wave of depolarization through the brain that quiets neurons and thus disrupts brain function. Lamictal has actions with the GABA/Glutamate system which essentially is one of the major gateways for releasing electrical charge through neurons. Lamictal essentially improves regulation of key gateways for neuron impulses and likely inhibits the cascade of neuron depolarization that happens in CSD resulting in migraine aura.
I am ranting about this, and singing my praises regarding these findings from the rooftops because this is ground breaking research that next to no one has heard of. Essentially with a little bit of funding and a few more studies we would likely know for sure one of the major mechanism for migraine aura, and understand why a medication appears to be extremely effective in prevention for those with migraine with aura.
The research and a summary on Cortical Spreading Depression
- Lamotrigine reduces migraine aura and migraine attacks in1
patients with migraine with aura1 (Journal of Neurology, Neurosurgery and Psychiatry, 2005)
- Preventing disturbing migraine aura with lamotrigine: an open study2 (Headache, 2004)
- Theory Behind Migraine Emerges3 (DANA, 2008)
- Cortical spreading depression as a target for anti-migraine agents4 (Journal of Headache Pain, 2013)
How Lamictal Has Completely Changed my Life
I started Lamictal in August after about everything else had been tried. I had read these studies almost a year prior, however, I had been a bit disillusioned by the reality of outcomes for things like Botox. My neurologist was also aware of the studies and offered up as a side note when discussing potential meds, “well there was this one study on a drug for migraine aura…” in the memory of my experience I remembered finishing the sentence, “Lamictal?”
If you’ve read this blog at all you know I have pretty spectacularly complex and disabling migraine auras. I have a grab bag of tingling, loss of muscle coordination, speech loss, confusion, short term memory loss, vertigo, motion blur of vision, loss of peripheral vision, and a few other symptoms. By August I’d been having at least 4 auras a week for over a year. The entire summer almost every afternoon I’d have to park in some random parking lot while my brain tripped out for a half an hour or so. It was not fun. I was also having moderate migraines pretty much everyday with a peppering of mild and severe days. Somehow I managed to keep working. At the end of this I’ll have a few articles linked on my auras and migraines.
I threw the Lamictal into my med box and proceeded to not really thing about it. Somewhere at the end of the second week or the beginning of the third I realized I hadn’t needed to pull over for mid afternoon crazy time for a few days. A few weeks later I wasn’t having aura at all. This entire time I was only on 25-50mg which is a baby dose. I honestly thought I was losing my mind because that is a very very short time span for a medication like that to start working, especially on a dose that low.
Then my migraines suddenly got very hard to treat, I would suddenly think “Wow I’m in a lot of pain, What is that? Oh it’s a migraine!”. I am a trooper at sublimating pain, and I new to look for a migraine when I started having aura. Hilariously when my auras were gone I kept repeatedly missing my treatment window. So I’d end up taking the DHE too late.
Then the migraines started to go away altogether. The ones that remained often required just Tylenol or no intervention at all. The next thing I knew I was down to 0-3 headaches a week.
This has been the worst week in the past two months, and I’ve only needed to take my DHE twice. The weather also suddenly decided to be seasonal, so there have been huge barometric shifts and temperature changes this week. Compared to other season changes in the past year and a half right now I should be have disabling auras and moderate to severe migraines. That is not happening, not even close. It’s also important to note that my vestibular issues have also improved greatly, even though my Meniere’s Disease is simmering in the background.
Lamictal has completely changed my life, and if I ever develop THE RASH (Steven Johnson’s Syndrome) they’ll need to yank my bottle of Lamictal out of my purple necrotic hands before I’ll stop taking it.
Update on 6/4: Since the full 300 year family tree of Basilar Migraine and Epilepsy in my family has been uncovered I am starting a trial of upping my Lamictal to 300mg a day. Essentially at my great grandfather we know that he passed Basilar Migraine onto the females, and Epilepsy to the males. This essentially means there may be some genetic and biochemical similarities between migraine aura and epilepsy.