Topiramate for migraine prevention: a randomized controlled trial

Area of Science:

• Neurology
• Clinical Pharmacology

Background:

• Previous trials indicated topiramate's potential for migraine prevention.
• This study aimed to confirm its efficacy and safety in a larger population.

Purpose of the Study:

• To evaluate the efficacy and safety of topiramate for preventing migraines in a large-scale, randomized, double-blind, placebo-controlled trial.

Main Methods:

• A 26-week trial randomized 483 patients (aged 12-65) with a history of migraines to receive placebo or topiramate (50, 100, or 200 mg/d).
• Topiramate was titrated over 8 weeks, followed by 18 weeks of maintenance treatment.
• Primary endpoint was the change in mean monthly migraine frequency; secondary endpoints included responder rates and reduction in migraine days.

Main Results:

• Topiramate at 100 and 200 mg/d significantly reduced monthly migraine frequency compared to placebo (P<.001).
• Responder rates were significantly higher across all topiramate doses (50, 100, 200 mg/d) versus placebo (P<.001).
• Significant reductions in migraine days and rescue medication use were observed with 100 and 200 mg/d topiramate.

Conclusions:

• Topiramate demonstrated significant efficacy for migraine prevention, with effects observed within the first month of treatment.
• The preventive effect of topiramate was maintained throughout the 26-week study duration.
• Common adverse events leading to discontinuation included paresthesia, fatigue, and nausea.