Migraines are more than just headaches; they can impact your work, sleep, and everyday life. While many people rely on standard treatments, not everyone finds effective relief. This has led to growing interest in alternative options, including medications not traditionally used for migraines. One such drug is pregabalin, which is commonly prescribed for nerve pain and seizures. But can it really help with migraines? Let’s discuss what the science and clinical studies suggest.

Understanding Migraine

A migraine is a severe headache that causes throbbing, pulsing pain on one side of your head. The headache phase of a migraine lasts at least four hours, but in some cases it can also last for days. The headache gets worse with bright lights, loud noises, strong fragrances, and physical activity.

Migraines are common, and studies indicate that an estimated 11.7% to 14.7%  of individuals in the US experience migraines [1].

What is Pregabalin?

Pregabalin is an anticonvulsant medicine used for the management of nerve pain associated with diabetic peripheral neuropathy, fibromyalgia, postherpetic neuralgia, and neuropathic pain associated with spinal cord injury. It is also used as an adjunctive therapy for the treatment of partial-onset seizures in patients 1 month of age and older [2].

Pregabalin for Migraine: Is it Effective

Pregabalin is sometimes used off-label for migraine prevention, particularly when other treatment options fail to offer results.

An NHS leaflet on migraine treatments for patients and carers notes that certain antiepileptic medications, such as Pregabalin (Nervigesic capsule), may also help manage migraines [3].

On the website Drugs.com,  Pregabalin has an average rating of 8.1 out of 10 for the off-label treatment of migraine. About 76% of reviewers reported a positive experience, while 12% of reviewers reported a negative experience [4].

It is important to consult a headache specialist to determine if this anticonvulsant is suitable, as it is generally considered after first-line treatments have failed.

How Does Pregabalin Work?

Pregabalin works by binding to the subunit of presynaptic voltage-gated calcium channels in your central nervous system. This reduces the release of neurotransmitters like glutamate, substance P, and CGRP. This mechanism reduces neuronal hyperexcitability and provides pain relief, making it a potential, though not primary, treatment for chronic migraine [5].

What Does the Research Say

According to a study by Elena P. Calandre et al., it is indicated that pregabalin may be a useful alternative for chronic migraine [6].

Another study published in 2011 suggested that pregabalin is an efficacious and safe anti-migraine agent in both chronic and episodic migraine patients [7].

How To Use Pregabalin

Pregabalin is available in three different forms, such as capsules, liquid, and extended-release tablets, and your doctor will help you figure out which one suits you best.

If you are taking it for migraines, you will usually start with a lower dose, around 75 mg, and gradually increase it over time if needed.

A few simple tips that you should remember are:

• You can take Pregabalin with or without food, whatever feels easier for you.
• Try to take it at the same time each day.
• If it makes you feel sleepy, taking it at night might work better.

Side Effects and Risks

Pregabalin capsules are generally safe, and you may not have any issues when you take them. But, like all medications, it can cause some unwanted effects.

Your adverse effects may depend on several factors, such as dosage strength, age, etc.

The most common side effects of this neuropathic pain agent are dizziness and sleepiness.

Other common side effects of this drug include blurred vision, dry mouth, weight gain, trouble concentrating, and swollen hands and feet.

Serious Side Effects:

Most patients don’t have any major issues with Pregabalin. But you could get swelling in your feet or legs, which is a big problem if you have a heart condition.

Although rare, you could have a serious allergic reaction. Get medical attention right away if you have:

• Skin redness.
• Breathing difficulties.
• Blisters or raised bumps on your skin.
• Swelling in your mouth, face, tongue, neck, or throat.
• Heartburn.

Like all antiseizure medications, Pregabalin can raise your chances of suicidal thoughts or actions. Tell your healthcare provider if your mood changes suddenly or gets worse.

Before you take Pregabalin`

Tell your doctor any other medicines you take, including over-the-counter medicines, vitamins, and herbal supplements. This is because Pregabalin can interact with some medications, which can make adverse effects more intense.

You should specifically mention if you take medications for any of the following:

Blood pressure: If you take blood pressure medications like angiotensin-converting enzyme inhibitors, Pregabalin can increase your risk of swelling or hives.

Pain or anxiety: You could get sleepy and dizzy if you pair Pregabalin with pain medicines like oxycodone or anxiety drugs like lorazepam.

Diabetes: If you combine diabetes medicines like Avandia, Metformin, or Actos with Pregabalin, you are more likely to gain weight or get swelling in your feet and hands.

Bring up any other medical ailments, including:

• Kidney issues
• Depression or other mood disorders.
• Substance abuse or addiction
• Bleeding problems or low blood platelet count.
• History of swelling issues.

Standard Migraine Treatments

There is no cure for migraines, but a doctor can help manage the symptoms of migraines through the following:

Medications

A medical provider might recommend taking medicines to treat migraines. There are two types of drugs available:

Medications to prevent migraines: A healthcare professional usually prescribes preventive medicines if you experience severe symptoms that interfere with your daily routine or have frequent migraines. These medicines alleviate how often and how severe migraines affect you. You can take these medicines as directed, usually every day.

Medications to stop migraines: You can take these medicines at the first sign of a migraine. They reduce or stop the symptoms of migraine-like nausea, pain, sensitivity, and more.

Common medicines that help stop migraines are the following:

• Ditans (lasmiditan)
• Antiemetic medications (metoclopramide)
• Triptans (5-hydroxytryptamine)
• Gepants (rimegepant and ubrogepant)
• Dihydroergotamine (prochlorperazine).

Common medications to prevent migraines are

• Monoclonal antibodies (erenumab, fremanezumab, and galcanezumab).
• Calcium channel blockers (verapamil).
• Beta-blockers (atenolol, propranolol, nadolol).
• Serotonin and norepinephrine reuptake inhibitors (venlafaxine, duloxetine).

Medicines come in several forms, like:

• An oral medication
• An injection under your skin
• Suppository (a solid, small medicine that is inserted into a body cavity where it dissolves at body temperature to release the medicine).
• A nasal spray.
• Through an IV

Note: Your medical provider will discuss the specific medication, combination of medicines, and formulations to best manage your symptoms.

Over-the-counter migraine drugs

Over-the-counter migraine medicines are effective if you have moderate migraine symptoms. The main ingredients in pain-alleviating medications are aspirin, ibuprofen, naproxen, acetaminophen, and caffeine.

Be cautious when taking over-the-counter pain relief medications [8].

Alternative Tips for Migraine Management

If you are experiencing migraine headaches, you know how painful the condition is and how difficult it is to make a migraine attack go away. Preventive and early actions when a migraine strikes are important to keeping this condition under control.

Below are some tips you can try to help relieve migraines early and keep them from getting worse.

Cold compress 

Applying a cold compress can help when you have a migraine. Cold therapy has been used to address migraine pain for over a century, with proposed mechanisms that include blood vessel constriction and slowed nerve signaling, which can alleviate pain and inflammation.

Hydrate

Dehydration can cause migraine attacks. If you don’t drink enough water regularly, increasing your water intake may help reduce your migraine pain and prevent repeat attacks.

Eat ginger

Some foods can help prevent migraines. Ginger is one such food. A research study found that ginger reduced migraine pain significantly in 2 hours, as well as vomiting and nausea that are associated with migraines.

While most of the studies used powdered ginger, other products, including candies and teas, might offer relief.

Relax in a dark place

Sensitivity to sound and light is one of the most common symptoms of migraine. Get away from these things if possible. This can help you get relief from your pain and reduce stress.

Lie down and pay attention to your breathing. Try to take slow, deep breaths from your diaphragm. Feel your stomach rise as you inhale and fall with the exhale. This can help you relax.

Try caffeine

For some people, a cup of tea or coffee may help stop a migraine. For others, caffeine can trigger migraines.

Regardless, if you do indulge in caffeine, ensure you don’t drink too much. Drinking more than a cup of coffee could set you up for a caffeine withdrawal headache later.

Individuals with migraines who use caffeine more than 3 days per week may develop dependency. This can result in more headaches. Therefore, moderation is key with caffeine intake, but it helps many people find relief [9].

When To See Your Doctor

The sharp pain that comes with a migraine is frustrating. Talk with your healthcare professional about when to seek emergency treatment.

Pain is not usually considered an emergency, but if it impacts your ability to do your daily tasks, it’s definitely a situation that needs more care.

You should seek treatment immediately if you have a sharp headache accompanied by:

• Loss of balance or coordination.
• Uncontrollable vomiting.
• Seizures or convulsions.
• Intolerable pain.
• Lightheadedness.
• Blurred vision or other vision changes.
• A pounding in your chest
• High blood pressure.

Conclusion

Pregabalin is not usually the first treatment doctors choose for migraines. However, it can be a helpful option for some people, especially when standard medications do not provide enough relief. It works by calming overactive nerves in the brain, which may reduce the frequency and intensity of migraine attacks in certain cases.

This medication may come with side effects like dizziness or sleepiness. This is why it’s important to take it only under medical supervision and follow the prescribed dosage carefully.

If you are dealing with frequent or severe migraines, speak with your healthcare provider. They can offer you the most effective treatment plan.