PO-31 | Could lamotrigine represent an effective treatment strategy in patients with migraine with aura? An observational study

M. Marziani, M. Silvestro, I. Orologio, L. Tartaglione, F.M. Chianese, A. Tessitore, A. Russo | Headache Centre, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Italy

Background: Although several drugs have demonstrated efficacy in the preventive treatment of migraine without aura, no pharmacological intervention has been specifically evaluated for patients experiencing only migraine with aura. Preclinical data suggest that glutamatergic hyperactivity underlies the cortical hyperexcitability observed in this patient population, particularly within the visual cortex. In this context, the present observational study aimed to assess the effectiveness of lamotrigine in patients exclusively affected by migraine with aura.

Methods: Thirty-seven patients diagnosed with migraine with aura according to the ICHD-III criteria (18 with complex aura, 19 with simple aura), each experiencing at least one attack per month, were enrolled in the study. Patients received lamotrigine at doses ranging from 50 to 100 mg daily. Clinical data, including monthly aura frequency and duration, were collected prospectively before and after treatment. The primary outcome was the proportion of patients achieving a ≥50% reduction in monthly migraine with aura attacks. Secondary outcomes included changes in the mean frequency of attacks and aura duration.

Results: Of the 37 patients (28 females, 9 males; mean age 43 years), 25 (65.79%) and 36 (97.3%) experienced a ≥50% reduction in the frequency of migraine with aura attacks respectively at both 3 and 6 months of treatment. Mean attack frequency decreased significantly from 4 ± 4 to 1 ± 0.5 per month, and mean aura duration decreased from 23.57 ± 14.04 to 19.38 ± 21.07 minutes. No adverse events were reported. These findings support the efficacy and tolerability of lamotrigine as a preventive treatment for migraine with aura. We hypothesize that lamotrigine may mitigate aura symptoms by reducing glutamate release and thus decreasing cortical hyperexcitability in the visual cortex. This effect likely involves the inhibition of presynaptic voltage-gated sodium, potassium, and calcium channels, thereby reducing susceptibility to cortical spreading depression.

Conclusion: Despite the limited sample size, these preliminary results suggest that lamotrigine may represent a promising preventive option for patients with migraine with aura. Larger, controlled studies are warranted to confirm and expand upon these findings.