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Topiramate in migraine prophylaxis: a randomised double-blind versus placebo study
1Center for the Study of Headaches, Policlinico Universitario Agostino Gemelli, Istituto di Neurologia, L.go Agostino Gemelli 8, I-00168 Rome, Italy. alessandro.capuano@libero.it
Summary
Topiramate (TPM) effectively reduced migraine frequency and symptomatic drug use in a 16-week study. This antiepileptic drug demonstrated good tolerability for migraine prophylaxis, offering a new treatment option.
Area of Science:
- Neurology
- Pharmacology
Background:
- Migraine is a prevalent neurological disorder causing significant disability.
- Neuronal hyperexcitability is a proposed mechanism underlying migraine pathophysiology.
- Antiepileptic drugs are being investigated for migraine prophylaxis.
Purpose of the Study:
- To evaluate the efficacy and tolerability of topiramate (TPM) at 100 mg/day for migraine prophylaxis.
- To assess TPM's impact on migraine crisis frequency, symptomatic drug usage, and disability days.
Main Methods:
- A 16-week randomized, double-blind, placebo-controlled study with a 4-week run-in period.
- 115 patients were randomized to receive either topiramate (TPM) or placebo.
- Outcome measures included migraine frequency, use of symptomatic medications, and disability days.
Main Results:
- Topiramate significantly reduced migraine crisis frequency from 5.26 to 2.60 in the last 4 weeks.
- TPM treatment led to a significant decrease in symptomatic drug use compared to placebo (2.57 vs. 6.17).
- A significant downward trend in disability days was observed in the TPM group over the 16-week therapy period.
Conclusions:
- Topiramate (100 mg/day) is effective and well-tolerated for migraine prophylaxis.
- TPM offers a viable therapeutic option for reducing migraine burden and associated disability.
- The study supports the use of antiepileptic drugs in managing migraine.