Paresthesia as a favorable predictor of migraine prophylaxis using topiramate

Abstract

Migraineurs treated with topiramate often experience adverse effects, such as paresthesia, fatigue, memory difficulty, or taste perversion. To investigate correlations between side effects and drug efficacy, we analyzed for these in 133 migraineurs treated with topiramate (100 mg/day). A 4-week baseline screening phase preceded a 4-week titration period and a 20-week maintenance phase. A total of 118 patients were evaluated at 3 months and 89 patients at 6 months. Patients who developed paresthesia (n = 73) showed lower headache days than those who did not (n = 60) (P = 0.026 at 3 months, P = 0.002 at 6 months), and had a higher responder rate (3 months, 57.5% and 6 months, 65.8%) than those who did not develop paresthesia (3 months, 38.3% and 6 months, 41.7%). Moreover, retrospective analysis of patients that dropped out showed no survival bias between paresthesia and headache improvement. Other adverse effects were not found to correlate with drug efficacy. This study suggests that the development of paresthesia predicts a favorable response to topiramate in migraine prophylaxis.

Topiramate for the Treatment of Chronic Corneal Pain

“…Topiramate frequently causes paresthesias. 37,40,41 One potentially beneficial side effect of topiramate is weight loss. Patients taking 100 mg daily of topiramate showed a mean weight reduction of 3%.…”

“…39 Side effects of topiramate also include upper respiratory tract infection and taste alteration. 41 In 1 recent randomizedcontrolled study using an effective mean dose of 86 mg of topiramate daily, most side effects were classified as mild to moderate. Adverse effects led to a dropout rate of 10% in the treatment group and 6% in the placebo group.…”

Clinical pharmacology of topiramate in migraine prevention

“…Migraine patients seem exceptionally susceptible to paresthesia compared with patients with other diseases [74]. However, it has been suggested that the development of paresthesia could predict a favorable response to topiramate in migraine prophylaxis [75].…”

Efficacy of Zonisamide in Migraineurs with Nonresponse to Topiramate

“…As a result of these adverse events, a large number of migraineurs dropped out, mainly due to paresthesia, which is induced by inhibition of carbonic anhydrase [12]. …”

“…The purpose of this study was to overcome the migraine prophylaxis with zonisamide in patients refractory to topiramate because the limitations of topiramate in migraineurs were adverse reactions, such as paresthesia, fatigue, memory difficulties, loss of appetite, and weight loss [11, 12]. In this study, we determine potential effectiveness of zonisamide for migraine prophylaxis in patients refractory to topiramate and assess adverse events of zonisamide.…”