Medical Health Encyclopedia

Gabapentin. Another anti-seizure drug that has shown some benefit in isolated cases is gabapentin (Neurontin). Research on this drug in patients with cluster headaches, however, remains very limited.

Side Effects of Valproate and Other Anti-Seizure Agents. The side effects given here are associated with valproate. Other anti-seizure agents have similar effects and some specific ones of their own. Most are usually minor, occurring early in therapy, and then subsiding. Those of valproate include the following:

• Gastrointestinal problems (nausea, vomiting, heartburn). (In some studies, such side effects occurred initially in half the patients taking valproate.)
• Headaches.
• Visual disturbances.
• Ringing in the ear.
• Hair loss.
• Weight gain (a significant problem with valproate). In one study 23% of valproate-treated patients gained weight. (Other anti-seizure agents, such as topiramate, may actually be helpful for reducing treatment-related weight gain.)
• Agitation.
• Odd movements.
• In women, menstrual irregularities and a higher risk for polycystic ovary syndrome (PCO). (These side effects also appear in women using other anti-epileptic drugs, but the risk for those taking valproate may be higher.)
• The drug significantly increases the risk for birth defects when taken by pregnant women. (Valproate is, however, the preferred drug for women taking oral contraceptives.)
• Cognitive impairment and symptoms of Parkinson's disease. (One study of patients taking valproate for epilepsy for longer than a year reported these side effects in some patients. They resolved when valproate therapy was discontinued.)

Very serious side effects are rare but include the following:

• Liver damage.
• Convulsions.
• Coma.
• Pancreatitis in adults and children. This can be life threatening.

Capsaicin

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A nasal spray form of capsaicin called civamide (Zucapsaicin) has shown promise in the prevention and treatment of cluster headaches. Capsaicin is a component of hot red peppers that seems to reduce substance P, a chemical in the body that contributes to inflammation and the delivery of pain impulses. In a small 2002 study, daily use of intranasal civamide resulted in more than a 50% reduction in headaches. Side effects include a burning sensation and excessive tearing.

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