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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
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.
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.