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Topiramate for migraine prevention.

Richard G Wenzel1, Kerry Schwarz, Rosalyn S Padiyara

  • 1Diamond Headache Clinic Inpatient Unit, Chicago, Illinois 60613, USA. rwenz@hotmail.com

Pharmacotherapy
|March 1, 2006
PubMed
Summary

Topiramate at 100 mg/day effectively reduces monthly migraine attacks by approximately two in adults. This dosage offers a favorable balance of efficacy and tolerability for migraine prevention.

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Area of Science:

  • Neurology
  • Pharmacology

Background:

  • Migraine is a prevalent, costly neurological disorder often underdiagnosed and undertreated.
  • Topiramate was approved by the FDA in 2004 for adult migraine prevention.

Purpose of the Study:

  • To evaluate the efficacy and tolerability of topiramate for migraine prevention.
  • To determine the optimal dosage of topiramate for migraine prophylaxis.

Main Methods:

  • Systematic literature review of published studies and clinical experience.
  • Analysis of three large, randomized, placebo-controlled trials of topiramate for migraine prevention.
  • Inclusion of a comparator trial with propranolol.

Main Results:

  • Topiramate 100 mg/day significantly reduced monthly migraine attacks by approximately two.
  • This dosage also decreased migraine days and acute treatment use.
  • Paresthesia was the most common dose-related side effect leading to discontinuation.

Conclusions:

  • Topiramate 100 mg/day is an effective option for adult migraine prophylaxis.
  • The robust trial design supports topiramate as a preferred agent for migraine prevention.
  • Future research should incorporate quality-of-life outcomes.

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