Perimenstrual migraines and their response to preventive therapy with topiramate

Preventive treatment with topiramate is effective for overall reduction of migraine frequency, but there are few data regarding its efficacy on perimenstrual migraines. To determine whether topiramate can prevent perimenstrual migraines, we analyzed data from premenopausal women as a subgroup of the Prolonged Migraine Prevention with Topiramate (PROMPT) study.

In total, 198 women from the PROMPT study with menstrually related migraine (MRM) were evaluated. After a one-to-two-month prospective baseline period, patients received open-label topiramate (50-200 mg/day) for six months.

During topiramate treatment, mean monthly migraine frequency was reduced from 7.03 at baseline to 4.36 (mean change: -2.66; p < .001, endpoint analysis). Mean percentage reductions were similar for migraines during and outside the perimenstrual period (-45.9% and -46.1%, respectively). In patients with aura, reductions in migraine days with (-48.3%) or without (-43.4%) aura were similar to those in patients without aura (-45.4%). Reductions were also similar whether women were taking combined oral contraceptives (-47.0%) or were not (-46.6%).

Topiramate reduces the frequency, but not severity or duration, of perimenstrual migraines in women with MRM, including migraines with and without aura, and regardless of combined oral contraceptive use.