New generation anti-epileptics for facial pain and headache

The prophylactic management of recurrent head and facial pains mar be chall enging because of lack of efficacy and/or bothersome adverse effects of ava ilable drug therapies. New generation antiepileptic drugs offer new perspec tives in difficult cases. We will review the available published data and p resent our experience with lamotrigine in various head and facial pains suc h as migraine, cluster headache, neuropathic trigeminal pain, atypical faci al pain, and chronic tension-type headache. Twenty-five patients were enrol led and followed for 18 months. The dose was gradually increased in steps o f 25 mg up to the effective dose (mean 250 mg/d). Lamotrigine was most effe ctive in trigeminal neuralgia and dysesthesia, but was of little utility in the other head or facial pains.