Brief facts: Retrospective observational study conducted between 2014 and 2022, involving 81 patients without control group.
Around 1.5 million people in Sweden suffer from migraine. Migraine affects both individuals’ daily lives and society as a whole. The disease limits the ability to work and participate in social activities, and leads to significant costs through sick leave, reduced productivity and increased healthcare needs. Women are three times as likely to be affected as often as men, a difference that is largely due to hormonal factors.
Up to a third of people with migraine experience aura – a temporary neurological symptom that can cause visual disturbances, loss of vision, sensory disturbances, balance problems, and speech and language difficulties, among other symptoms. For some patients, aura is the most debilitating symptom of the disease, but there is currently no established treatment that specifically targets it.
“Around 50,000 people in Sweden suffer from aura-dominant migraine. Aura is thought to be linked to cortical spreading depolarisation (CSD), a slowly progressing wave of altered nerve cell activity in the cerebral cortex,” says Gürdal Sahin, a researcher at Lund University and a specialist in neurology at the Skåneuro private clinic.
Migraine with aura is also associated with a slightly increased risk of ischaemic stroke, particularly when combined with other vascular risk factors. It is therefore important to reduce modifiable risk factors.
“There are now several effective treatments for migraine, including new medicines that block the neurotransmitter CGRP, which plays a key role in migraine attacks. Botulinum toxin is also used as a preventative treatment for chronic migraine. However, as there is no established treatment that specifically targets the aura itself, migraines with and without aura are often treated in a similar way, even though the aura appears to be partly based on mechanisms other than the headache itself,” Gürdal Sahin continues.
The medicine lamotrigine is approved for the treatment of epilepsy and bipolar disorder, but not for migraine. However, as both epilepsy and migraine aura involve temporary changes in nerve cell activity, the researchers wanted to investigate whether the drug could also prevent aura. Lamotrigine affects the electrical activity of nerve cells by acting on sodium and potassium channels, and also reduces the release of, amongst other things, the neurotransmitter glutamate. In this way, the medicine can reduce the excessive excitability of the nerve cells. In theory, these mechanisms could help to prevent the emergence and spread of CSD.
“In our study, we examined 81 patients with frequent or particularly troublesome migraine aura and treated them with lamotrigine. Among the patients included the number of days with aura fell on average from 6.9 to 1.4 days per month, representing a reduction of around 80 per cent,” says Sena Uzun, a doctoral student at Lund University.
While previous studies involving lamotrigine have shown mixed results, the results of this study were particularly promising for patients with aura-dominant migraine. In this group, 85 per cent of patients experienced at least a 50 per cent reduction in the number of days with aura. Another interesting observation was that a slower dose escalation was associated with fewer side effects, which may be relevant when the treatment is evaluated in future clinical trials.
“As the study is retrospective and lacks a control group, the results need to be confirmed. We are now proceeding with a national, randomised, double-blind, placebo-controlled trial of lamotrigine. If the results can be confirmed, the drug could become a relatively inexpensive and well-established treatment option for a group of patients who currently have no treatment for the aura itself,” concludes Sena Uzun.
Migraine attacks are usually divided into four phases, although not all sufferers experience all of them during every attack.
Frontiers in Neurology
Observational study
People
Lamotrigine prophylaxis is associated with reduced aura frequency in patients with burdensome migraine aura: a retrospective observational study
29-Jul-2026
GS has received consulting and speaking fees from Allergan, AbbVie, Lundbeck, Novartis, Pfizer, and Teva. He participated as principal investigator and national coordinator in clinical trials sponsored by AbbVie, Lundbeck, Pfizer, and Teva. UF has received consulting and speaking fees from Allergan, Lilly, Lundbeck, Novartis, and Teva. He participated as principal investigator in clinical trials sponsored by Amgen, Lundbeck, Novartis, and Teva. SU received a donation from the Lundbeck Foundation for the initiation of PhD studies. The remaining author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.