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The Evaluation of Topiramate as a First-Line Medication for Cluster Headache Prophylaxis: A Prospective Observational
Javid Shafiyev1, Irfan Gahramanov2
1The Neurology Department of the Central Military Hospital, Ministry of Defense.
Objective:
This study evaluated the effectiveness of topiramate monotherapy in treating episodic and chronic cluster headaches and its impact on headache-related disability and quality-of-life areas not sufficiently addressed in previous literature.
Materials And Methods:
A prospective observational study was conducted between October 2023 and December 2024, including 51 adults diagnosed with cluster headache. Exclusion criteria were other headache types, prior anticonvulsant use, malignancy, pregnancy, or lactation. Patients received topiramate starting at 25 mg/day, titrated weekly up to 100 mg. VAS (0 to 10) and HIT-6 scores were used to assess treatment efficacy and quality of life weekly.
Results:
The cohort was predominantly male (64.7%) with a mean age of 38.6 years. Significant reductions in both HIT-6 and VAS scores were observed over time in all patients, with similar efficacy between first-line and follow-up users. Chronic patients started with higher HIT-6 scores and showed slower improvement than episodic cases. Somnolence was the most common side effect (19.6%), but no patients discontinued treatment.
Conclusion:
In this observational cohort, topiramate monotherapy was associated with reductions in pain severity and headache-related disability and was generally well tolerated. These findings suggest that topiramate may be considered as a potential first-line or alternative prophylactic option in selected patients, particularly when treatment choices are limited or polypharmacy is undesirable.
