Introduction
Migraines are typically moderate or severe. They can last as long as three days at a time. It is not known exactly why migraines happen. It is thought that certain brain chemicals play a role. One of these brain chemicals is called gamma-aminobutyric acid or GABA. GABA affects how you feel pain.
Drugs such as topiramate and valproic acid, which affect GABA, are commonly used to help reduce the number or severity of migraines, but they don’t work for everyone. To increase the number of options, newer drugs have been studied for use in migraine prevention. These drugs include Neurontin and Lyrica.
Neurontin is a brand name for the drug gabapentin, and Lyrica is a brand name for the drug pregabalin. The chemical structures of both of these drugs are similar to GABA. These drugs seem to work by blocking pain in the way GABA does.
Neurontin and Lyrica are not currently approved by the Food and Drug Administration (FDA) to prevent migraines. However, they can be used off-label for this purpose. Off-label use means that your doctor can prescribe a drug for a condition that it isn’t approved for if they think that you may benefit from the drug.
Because the use of Neurontin and Lyrica for migraine prevention is off-label, there isn’t a standard dosage. Your doctor will decide what dosage is right for you. Other features of these two drugs are listed in the following table.
Learn more: What you need to know about off-label prescription drug use »
| Neurontin | Lyrica | |
| What is it approved to treat? | • seizures • nerve damage pain from shingles (a painful rash caused by herpes zoster infection) | • seizures (when taken with other drugs) • nerve damage pain from shingles (a painful rash caused by herpes zoster infection) • nerve damage pain from diabetes • nerve damage pain from spinal cord injury • fibromyalgia |
| What are the off-label uses? | migraine prevention | migraine prevention |
| Is it available as a generic drug? | yes | no |
| What forms does it come in? | • oral capsule • oral solution • oral tablet | • oral capsule • oral solution |
| Do I use it for long-term or short-term treatment? | long-term treatment | long-term treatment |
| How do I store it? | • Store the oral capsules between 59°F and 86°F (15°C and 30°C) • Store the oral solution in a refrigerator between 36°F and 46°F (2°C and 8°C) • Store the oral tablets between 59°F and 86°F (15°C and 30°C) | • Store the oral capsules between 59°F and 86°F (15°C and 30°C) • Store the oral solution in a refrigerator between 36°F and 46°F (2°C and 8°C) |
The American Academy of Neurology (AAN) is an organization that provides guidance for doctors about drugs for migraine prevention. The AAN has stated that there is not enough evidence at this time to support the use of Neurontin or Lyrica for migraine prevention.
However, some clinical trial results have shown a small benefit from the use of gabapentin (the drug in Neurontin) for migraine prevention. Likewise, results of some small studies have shown pregabalin (the drug in Lyrica) to be useful in preventing migraines. Your doctor may choose to prescribe either of these drugs if more commonly used drugs have not worked for you.
Read more: Detailed drug information for Neurontin (gabapentin) »
Neurontin and Lyrica are both band-name drugs, so their costs are similar. Most pharmacies carry both of them. Neurontin is also available as a generic drug, which usually costs less. Check with your pharmacy for the exact cost of each of these drugs.
Many insurance providers cover Neurontin and Lyrica. However, your insurance may not cover these drugs for an off-label use, which includes migraine prevention.
The following table highlights the side effects of Neurontin and Lyrica. Some of the common side effects are also serious.
| Neurontin | Lyrica | |
| Common side effects | • drowsiness • swelling of your hands, legs, and feet from fluid buildup • double vision • lack of coordination • tremor • trouble talking • jerky movements • uncontrollable eye movement • viral infection • fever • nausea and vomiting | • drowsiness • swelling of your hands, legs, and feet from fluid buildup • blurry vision • dizziness • unexpected weight gain • trouble concentrating • dry mouth |
| Serious side effects | • life-threatening allergic reactions • suicidal thoughts and behavior* • swelling of your hands, legs, and feet from fluid buildup • changes in behavior** such as aggressiveness, restlessness, hyperactivity, problems concentrating, and changes in school performance | • life-threatening allergic reactions • suicidal thoughts and behavior* • swelling of your hands, legs, and feet from fluid buildup |
**In children aged 3–12 years
Neurontin and Lyrica can interact with other drugs or other substances you may take. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.
For example, Neurontin and Lyrica can both interact with narcotic pain drugs (opioids) or alcohol to increase the risk of dizziness and drowsiness. Antacids can reduce the effectiveness of Neurontin. You should not use them within two hours of taking Neurontin. Lyrica also interacts with certain blood pressure drugs called angiotensin-converting enzyme (ACE) inhibitors and certain diabetes drugs, including rosiglitazone and pioglitazone. These drugs lead to increased risk of fluid buildup with Lyrica.
Your doctor must consider other medical conditions that you have before prescribing you Neurontin or Lyrica for migraine prevention.
Kidney disease
Your kidneys remove Neurontin or Lyrica from your body. If you have kidney disease or a history of kidney disease, your body may not be able to remove these drugs very well. This may increase the levels of the drug in your body and increase your risk of side effects.
Heart disease
Lyrica can cause unexpected weight gain and swelling of your hands, legs, and feet. If you have heart disease, including heart failure, these effects may worsen your heart function.
Neurontin or Lyrica may be an option to prevent your migraines, especially if other drugs have not worked. Talk to your doctor about all of your options. Your doctor knows your medical history and call tell you the treatment that has the best chance of working for you.