Time course of adverse events most commonly associated with topiramate for migraine prevention

Láinez, Miguel J. A.; Freitag, Fred; Pfeil, J.; Ascher, Steve; Olson, William H.; Schwalen, S.

doi:10.1111/j.1468-1331.2007.01869.x

Cited by 57 publications

(53 citation statements)

References 17 publications

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“…16,17 Preventive treatments aim to reduce headache frequency by at least 50 % 18-20 without intolerable harms. 21,22 In clinical practice, physicians and patients choose preventive treatments based primarily on FDA approval and drug tolerability. 9,18,19,[23][24][25] Systematic reviews and meta-analyses with consistent and transparent appraisal of study quality and strength of evidence are essential for arriving at evidence-based migraine preventive treatment and policy decisions.…”

Section: Introductionmentioning

confidence: 99%

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

et al. 2013

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ELIGIBILITY CRITERIA: English-language randomized controlled trials (RCTs) of preventive drugs compared to placebo or active treatments examining rates of ≥50 % reduction in monthly migraine frequency or improvement in quality of life. STUDY APPRAISAL AND SYNTHESIS METHODS:We assessed risk of bias and strength of evidence and conducted random effects meta-analyses of absolute risk differences and Bayesian network meta-analysis. RESULTS: Of 5,244 retrieved references, 215 publications of RCTs provided mostly low-strength evidence because of the risk of bias and imprecision. RCTs examined 59 drugs from 14 drug classes. All approved drugs, including topiramate (9 RCTs), divalproex (3 RCTs), timolol (3 RCTs), and propranolol (4 RCTs); offlabel beta blockers metoprolol (4 RCTs), atenolol (1 RCT), nadolol (1 RCT), and acebutolol (1 RCT); angiotensin-converting enzyme inhibitors captopril (1 RCT) and lisinopril (1 RCT); and angiotensin II receptor blocker candesartan (1 RCT), outperformed placebo in reducing monthly migraine frequency by ≥50 % in 200-400 patients per 1,000 treated. Adverse effects leading to treatment discontinuation (68 RCTs) were greater with topiramate, off-label antiepileptics, and antidepressants than with placebo. Limited direct evidence as well as frequentist and exploratory network Bayesian meta-analysis showed no statistically significant differences in benefits between approved drugs. Off-label angiotensin-inhibiting drugs and beta-blockers were most effective and tolerable for episodic migraine prevention. LIMITATIONS:We did not quantify reporting bias or contact principal investigators regarding unpublished trials. CONCLUSIONS: Approved drugs prevented episodic migraine frequency by ≥50 % with no statistically significant difference between them. Exploratory network meta-analysis suggested that off-label angiotensin-inhibiting drugs and beta-blockers had favorable benefit-to-harm ratios. Evidence is lacking for longterm effects of drug treatments (i.e., trials of more than 3 months duration), especially for quality of life.KEY WORDS: migraine; evidence based medicine; adverse drug effects.

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Section: Introductionmentioning

confidence: 99%

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

et al. 2013

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“…Both drugs proved equally effective in improving several pain/disability parameters, but the safety profile was higher for onabotulinumtoxinA and the discontinuation rate significantly higher for topiramate [adverse events (AEs) being the major reason for withdrawal] (discontinuation rates 25-44.2 % for topiramate; 10-25 % for onabotulinumtoxinA) [12,[65][66][67][68][69].…”

Section: Re-prophylaxismentioning

confidence: 98%

Update on Medication-Overuse Headache and Its Treatment

Giamberardino

Mitsikostas

Martelletti

2015

Curr Treat Options Neurol

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Medication-overuse headache-i.e., a too-frequent consumption of acute headache medications leading to increased headache frequency and reduced effectiveness of acute and preventive treatments-is a serious medical condition whose pathophysiology still remains incompletely known, which is reflected into a lack of mechanism-based treatments. The first mandatory step in the therapeutic strategy remains withdrawal of the abused drug, preferably abrupt, in concomitance with a detoxification pharmacological regimen to lessen withdrawal symptoms. Intravenous hydration, antiemetics, corticosteroids (prednisone), tranquilizers (benzodiazepine), neuroleptics, and rescue medication (another analgesic than the overused) should be delivered in various combinations, on an inpatient (hospitalization and day hospital) basis or outpatient basis, depending on the characteristics of the specific patient and type of overuse. Inpatient withdrawal should be preferred in barbiturate and opioid overuse, in concomitant depression, or, in general, in patients who have difficulty in stopping the overused medication as outpatients. In contrast, in overuse limited to simple analgesics in highly motivated patients, without high levels of depression and/or anxiety, home detoxification should be chosen. Re-prophylaxis should immediately follow detoxification, ideally with local injections of onabotulinumtoxinA every 3 months or topiramate orally for at least 3 months. Adequate information to patients about the risks of a too-frequent consumption of symptomatic headache medications is essential and should constantly parallel treatment to help preventing relapse after detoxification and re-prophylaxis.

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“…Lainez et al [36] analyzed three large multicentre studies, and found that therapy discontinuation occurred in 25% of patients administered Topiramate and in 1% of patients treated with placebo. The most common adverse events were paresthesias (8.0%), cognitive symptoms (7.3%), fatigue (4.7%), insomnia (3.4%), nausea (2.3%), loss of appetite, anxiety, and dizziness (2.1%).…”

Section: Topiramatementioning

confidence: 98%

Rehabilitating chronic migraine complicated by medication overuse headaches: how can we prevent migraine relapse?

Farinelli¹,

Dionisi

Martelletti³

2010

Intern Emerg Med

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Headache is among the most common neurological symptoms in clinical practice. In some cases of episodic migraine, the headache intensifies into a chronic form, defined as chronic migraine (CM) and such a condition encompasses a headache frequency of 15 days/month, with features similar to those of migraine attacks. The assessment of CM in the US general population ranges around 1.3-2%. Migraine progression from an episodic into a chronic form is realized through a period of time involving several months or years, during which an increase attack frequency occurs. Both Topiramate and Onabotulinum toxin A can be considered to be safe as well as effective medications, therefore, representing a treatment choice. Regarding drug abusers, the initial relief step always consists of drug interruption. Only after detoxification can a new prophylaxis therapy be commenced, which otherwise would be useless from the start. The feasible diagnostic setting for the tailored treatment of CM based on the application of pharmacogenomics will allow us in predetermining the efficacy of a single old and new drugs by avoiding abuse due to non-responsivity of the abused drug.

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Time course of adverse events most commonly associated with topiramate for migraine prevention

Cited by 57 publications

References 17 publications

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

Update on Medication-Overuse Headache and Its Treatment

Rehabilitating chronic migraine complicated by medication overuse headaches: how can we prevent migraine relapse?

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