Efficacy of Topiramate in Migraine Prophylaxis: A Retrospective Chart Analysis

• Published in: Headache Vol. 42; no. 8; pp. 804 - 809
• Main Authors: Von Seggern, Randal L., Mannix, Lisa K., Adelman, James U.
• Format: Journal Article
• Language: English
• Published: Boston, MA, USA Blackwell Science Inc 01-09-2002; Blackwell
• Subjects: Adolescent; Adult; Aged; anticonvulsant; Anticonvulsants - therapeutic use; Biological and medical sciences; Cardiovascular system; Female; Fructose - analogs & derivatives; Fructose - therapeutic use; headache; Humans; Male; Medical sciences; Middle Aged; migraine; Migraine Disorders - prevention & control; Neurology; Pharmacology. Drug treatments; Retrospective Studies; Topiramate; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Vasodilator agents. Cerebral vasodilators; Human; Sensitivity disorder; Topiramate; Nervous system diseases; Antimigrainous agent; Migraine; Weight loss; Cardiovascular disease; Anticonvulsant; Paresthesia; Cerebral disorder; Vascular disease; Prevention; Chemotherapy; Pain; Treatment; Follow up study; Central nervous system disease; headache; Neurological disorder; Mechanism of action; Cerebrovascular disease
• ISSN: 0017-8748; 1526-4610
• DOI: 10.1046/j.1526-4610.2002.02184.x

Objective.— Topiramate, a broad‐spectrum anticonvulsant with multiple mechanisms of action, may be effective in preventing migraine headaches. We report the results of a retrospective chart review of patients treated with topiramate for prophylaxis of migraine.
Methods.—Patients with a diagnosis of migraine who had at least one follow‐up visit after 4 weeks on topiramate were eligible; 69 patients (56 women and 13 men) aged 18 to 68 years met these criteria. Charts were reviewed for frequency of mild or moderate/severe headaches at the start of topiramate (baseline) and at all subsequent visits up to 24 weeks.
Results.—The 28‐day frequency of moderate/severe migraines declined significantly from baseline to end of treatment (10.6 ± 8.4 to 7.4 ± 7.7, respectively; P = 0.0004), whereas that of mild headaches did not demonstrate a significant change (from 11.8 ± 8.9 to 11.0 ± 10.0). Among the 38 patients who had not responded previously to 9 preventive medications, the monthly frequency of moderate/severe (but not mild) headaches decreased significantly from baseline to end of treatment. Patients who previously had not responded to <9 prior medications experienced significant declines in both mild and moderate/severe headaches. The most common adverse events were paresthesias, drowsiness, diarrhea, decreased appetite, and weight loss. Twenty‐seven patients discontinued topiramate therapy, 20 as a result of adverse events and 7 due to lack of response.
Conclusion.—Topiramate may be effective in reducing the frequency of both mild and moderate/severe migraine headaches. In particular, topiramate may offer relief to patients with moderate/severe migraines who do not respond to other treatments.