Topiramate seen as effective for migraine prophylaxis

NEW YORK (Reuters Health) – Results of a small randomized trial show that the preventive use of the antiepileptic drug, topiramate, significantly reduces the frequency of migraine.

Dr. J. R. Storey and colleagues, from the Upstate Neurology Consultants, Albany, New York, randomly assigned 40 migraine patients to topiramate or placebo. Over 8 weeks topiramate was titrated weekly, in 25-mg increments, to a maximum dose of 200 mg/day or the maximum dose tolerated.

During the following 8 weeks of maintenance therapy, patients receiving topiramate experienced significantly lower migraine frequency than patients receiving placebo, irrespective of other migraine preventions being used, the researchers found.

Among patients taking topiramate the mean 28-day migraine frequency was reduced by 35.6% compared with 13.5% among patients receiving placebo (p = 0.004). Of the patients taking topiramate, 26.3% experienced a 50% reduction in migraine frequency compared with 9.5% of patients taking placebo (p = 0.226), Dr. Storey's team reports.

Topiramate was well tolerated, with only two of the 19 patients receiving topiramate stopping treatment because of adverse events. The most frequent adverse effects included paresthesia, weight loss, altered taste, anorexia, memory loss, dysarthria, abnormal vision, emotional lability, anxiety, and urinary frequency, according to the report in the November/December 2001 issue of Headache: The Journal of Head and Face Pain.

Despite these results, the editors of the journal question the validity of the findings. Although the reduction in 28-day migraine frequency may be statistically significant, the actual figures of 3.31 migraines per 28 days for patients taking topiramate versus 3.83 for patients receiving placebo appear to be clinically insignificant, they note.

Furthermore, they stress that only 26.3% of the patients achieved a 50% or more reduction in migraine frequency. "In a nutshell, these therapeutic results are not very impressive," the journal editors say.

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