Gabapentin (Neurontin)

Eur J Neurol. 2007 Jun;14(6):694-6.

The use of gabapentin in chronic cluster headache patients refractory to first-line therapy.

Schuh-Hofer S, Israel H, Neeb L, Reuter U, Arnold G.

Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.sigrid.schuh-hofer@gmx.net

Chronic cluster headache (CCH) is a rare but challenging condition. About 20% of CCH patients get refractory to treatment. Gabapentin has recently been reported to be efficacious in the treatment of CCH. To test the potential of gabapentin as second-line drug, we prospectively studied the efficacy of gabapentin as add-on drug in eight patients suffering from CCH refractory to first-line treatment. Six of eight CCH patients responded to treatment. After the end of the study phase, the patients' clinical course was further followed up until January 2006. The longest period of being continuously pain-free under gabapentin treatment was 18 months. In some individuals, increasing doses were needed with time. We conclude that gabapentin may be offered as treatment trial in patients refractory to first-line treatment. However, patients may fail to respond to treatment and drug tolerance may occur with time.

PMID: 17539953

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Reg Anesth Pain Med. 2001 Jul-Aug;26(4):373-5.

Gabapentin for the treatment and prophylaxis of cluster headache.

Tay BA, Ngan Kee WD, Chung DC.

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China. tabenai@cuhk.edu.hk

BACKGROUND AND OBJECTIVES: Cluster headache is an uncommon debilitating condition for which effective management remains a challenge. We describe the use of gabapentin in the treatment and prophylaxis of cluster headache in a patient who was refractory to other treatments. CASE REPORT: A 38-year-old man had a history of intermittent right-side headaches for 24 years, diagnosed as cluster headache. He received only partial relief from a range of conventional treatments. A trial with gabapentin 300 mg twice daily was tried and found to be effective in treatment and prophylaxis of his headaches. CONCLUSION: Gabapentin was effective in the treatment of a patient with cluster headache. Further investigation of gabapentin compared with conventional treatments and placebo is warranted.

PMID: 11464360

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Cephalalgia 2001 Sep;21(7):744-6.

Drug-resistant cluster headache responding to gabapentin: a pilot study

Leandri M, Luzzani M, Cruccu G & Gottlieb A.

Dipartimento di Oncologia, Biologia e Genetica, Università di Genova and Centro Interuniversitario per la Neurofisiologia del Dolore, Genova, Italy. cind@unige.it

Prompted by the results of gabaergic drugs, such as valproate and topiramate, we performed this pilot study to assess the effect of gabapentin in cluster headache. Eight patients suffering from episodic cluster headache and four suffering from chronic cluster headache were studied. All of them had failed to respond to traditional prophylactic drugs. The design of the study was an open trial. The main parameter for effectiveness was the number of daily attacks. Gabapentin was given at the daily dosage of 900 mg. All patients were pain free after a maximum of 8 days after starting therapy, with a bout duration thus reduced to 16-40% of the average previous bouts (only applies to episodic cluster patients). We hypothesize that the gabaergic action of gabapentin, perhaps combined with other mechanisms, such as calcium channel blockade, may be responsible for its remarkable effects on cluster headache.

PMID: 11595003

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