A double-blind, randomized trial of low-dose topiramate vs propranolol in migraine prophylaxis

Ashtari, Fereshteh; Shaygannejad, Vahid; Akbari, Mojtaba

doi:10.1111/j.1600-0404.2008.01087.x

Cited by 59 publications

(56 citation statements)

References 19 publications

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“…Two additional Class I studies report topiramate is as effective as propranolol 16 or sodium valproate, 17 drugs previously established as effective for migraine prevention. In the first study, subjects given topiramate 50 mg/day had reduced mean migraine frequency (episodes/month) from baseline (6.07 Ϯ In a crossover Class I trial (2-month washout between therapies) comparing topiramate 50 mg/day with sodium valproate 400 mg/day, both groups showed improvement from baseline in headache frequency, intensity, and duration.…”

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confidence: 99%

Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults

et al. 2012

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Objective: To provide updated evidence-based recommendations for the preventive treatment of migraine headache. The clinical question addressed was: What pharmacologic therapies are proven effective for migraine prevention? Methods:The authors analyzed published studies from June 1999 to May 2009 using a structured review process to classify the evidence relative to the efficacy of various medications available in the United States for migraine prevention. Results and Recommendations:The author panel reviewed 284 abstracts, which ultimately yielded 29 Class I or Class II articles that are reviewed herein. Divalproex sodium, sodium valproate, topiramate, metoprolol, propranolol, and timolol are effective for migraine prevention and should be offered to patients with migraine to reduce migraine attack frequency and severity (Level A). Frovatriptan is effective for prevention of menstrual migraine (Level A). Lamotrigine is ineffective for migraine prevention (Level A). Neurology Epidemiologic studies suggest approximately 38% of migraineurs need preventive therapy, but only 3%-13% currently use it.1 In 2000, the American Academy of Neurology (AAN) published guidelines for migraine prevention.2,3 Since then, new clinical studies have been published on the efficacy and safety of migraine preventive therapies. This guideline seeks to assess this new evidence to answer the following clinical question: For patients with migraine, which pharmacologic therapies are proven effective for prevention, as measured by reduced migraine attack frequency, reduced number of migraine days, or reduced attack severity? This article addresses the safety and efficacy of pharmacologic therapies for migraine prevention.Separate guidelines are available for botulinum toxin. 4 The 2008 guideline included a Level B recommendation that botulinum toxin was probably ineffective for treatment of episodic migraine. A new guideline is in development. An updated guideline on nonsteroidal anti-inflammatory drugs 5 and complementary alternative treatments has been approved for publication as a companion to this guideline. 5 DESCRIPTION OF THE ANALYTIC PROCESSThe AAN and the American Headache Society participated in the development process. An author panel of headache and methodologic experts was assembled to review the evidence. Computerized searches of the MEDLINE, PsycINFO, and CINAHL databases identified new studies (published in English). The search strategy used the MeSH term "headache" (exploded) and a published search strategy for identifying randomized controlled trials ( Appendices e-1-e-5, reference e1, and tables e-1 and e-2 are available on the Neurology Web site at www.neurology.org.

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confidence: 99%

Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults

et al. 2012

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“…A prior study testing low-dose topiramate vs propranolol demonstrated that both low-dose topiramate and propranolol significantly reduced migraine headaches. 20 Although this study did not include a placebo comparator, other placebocontrolled trials have shown propranolol and topiramate each as efficacious monotherapy in people with migraine. 9 The CMTT was performed in a large cohort of practices that were part of the National Institute of Neurological Disorders and Stroke Clinical Research Collaboration.…”

Section: Continuous Headache N (%)mentioning

confidence: 99%

Randomized, placebo-controlled trial of propranolol added to topiramate in chronic migraine

Silberstein

Dodick²,

Lindblad

et al. 2012

Neurology

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Objective: To assess the efficacy and safety of adding propranolol to topiramate in chronic migraine subjects inadequately controlled with topiramate alone. Methods:This was a double-blind, placebo-controlled, randomized clinical trial conducted through the National Institute of Neurological Disorders and Stroke Clinical Research Collaboration, expected to randomize 250 chronic migraine subjects inadequately controlled (Ն10 headaches/ month) with topiramate (50-100 mg/day) to either propranolol LA (long acting) (240 mg/day) or placebo. Primary outcome was 28-day moderate to severe headache rate reduction at 6 months (weeks 16 to 24) compared with baseline (weeks Ϫ4 to 0). Results:A planned interim analysis was performed after 48 sites randomized 171 subjects. The data and safety monitoring board recommended ending the trial after determining that it would be highly unlikely for the combination to result in a significant reduction in 28-day headache rate compared with topiramate alone if all 250 subjects were randomized. No safety concerns were identified. At study closure, 191 subjects were randomized. The 6-month reduction in moderate to severe 28-day headache rate and total 28-day headache rate for combination therapy vs topiramate alone was not significantly different: 4.0 vs 4.5 days (moderate to severe 28-day headache rate; p ϭ 0.57) and 6.2 vs 6.1 days (total 28-day headache rate; p ϭ 0.91). Conclusions:This study does not provide evidence that the addition of propranolol LA to topiramate adds benefit when chronic migraine is inadequately controlled with topiramate alone. Classification of evidence:This study provides Class II evidence that propranolol LA, added to topiramate, is ineffective in chronic migraine patients who fail topiramate monotherapy. Neurology

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“…Furthermore, in topiramate group, patients complained of more adverse effects than propranolol group (23.4% vs. 14.3%). So, comparative studies of propranolol with topiramate showed that topiramate was more effective especially in Iran (Ashtari et al 2008) 13 but present study showed that, propranolol is more effective than topiramate in migraine prophylaxis probably due to poor metabolism of propranolol in our regional context (Correia, 2009) 18 .…”

Section: Discussionmentioning

confidence: 78%

“…A good number of the study patients were 18-25 years age group in both groups (42.6% vs. 42.9% 13 found that the topiramate group showed more reduction in migraine frequency than propranolol group. These results are not similar to this study probably due to racial variation.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of Low Dose Topiramate and Propranolol in Migraine Prophylaxis

Khan

Ferdous²,

Kabir

et al. 2018

J Shaheed Suhrawardy Med Coll

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A double-blind, randomized trial of low-dose topiramate vs propranolol in migraine prophylaxis

Abstract: This study demonstrated that both low-dose topiramate and propranolol could significantly reduce migraine headache frequency, intensity, and duration. However, compared with propranolol, low-dose topiramate showed better results.

Cited by 59 publications

References 19 publications

Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults

Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults

Randomized, placebo-controlled trial of propranolol added to topiramate in chronic migraine

Efficacy of Low Dose Topiramate and Propranolol in Migraine Prophylaxis

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