Anticonvulsionantes: Profilaxis de migraña
Anticonvulsants: Migraine prophylaxis
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Múltiples medicamentos han sido utilizados en la profilaxis de la migraña y dentro de estos los anticonvulsivantes como el ácido valproico, topiramato y gabapentín han demostrado utilidad en la disminución del número y severidad de los ataques en cerca del 50%. Sus mecanismos de acción involucran interacciones con los canales de Na, K, Cl, Ca y neurotransmisores como glutamato, GABA y Ca, mediante las cuales los AC regulan la hiperexcitabilidad cortical y la disregulación neuromoduladora que constituyen las principales alteraciones fisiopatológicas en la migraña. Entre los AC el ácido valproico posee mayor acción profiláctica y similar efectividad a la lograda con propanolol. Ninguno puede considerarse de elección y la individualización del paciente es la principal guía para la selección del tipo de fármaco profiláctico. Abreviaturas: MG, migraña; AC, anticonvulsivantes; GABA, ácido gamma-aminobutírico; AMPA, ácido a-amino-3-hidroxi-5-metil-4-isoxalone propiónico; AVP, ácido valproico; TPM, topiramato; GPT, gabapentín; LTG, lamotrigina.
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