Topiramate and Triptans Revert Chronic Migraine With Medication Overuse to Episodic Migraine

Mei, D.; Ferraro, Diana; Zelano, Giovanni; Capuano, Alessandro; Vollono, Catello; Carbone, Gabriele; Trapani, G. Di

doi:10.1097/01.wnf.000022888.49044.99

Cited by 72 publications

(51 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…78 Divalproex in a larger dose of 1,500 mg/day increased the likelihood of a >50 % improvement in whether migraine attacks impaired usual activities or necessitated symptomatic medication and in reducing migraine attacks with nausea, vomiting, phonophobia, or photophobia. 79 Topiramate 73,74,[80][81][82] and propranolol decreased use of drugs for acute migraine attacks. 83 Among off-label drugs, pooled analyses offered lowstrength evidence that the beta-blocker metoprolol (approved for migraine prevention in Europe) and calcium channel blocker nimodipine were better than placebo in reducing monthly migraine attacks by ≥50 % ( Table 2).…”

Section: Resultsmentioning

confidence: 99%

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

et al. 2013

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 99%

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

et al. 2013

View full text Add to dashboard Cite

show abstract

“…[52] Another study suggesting the value of topiramate preventive therapy in reducing resource utilization in migraine was conducted in patients with chronic migraine and medication overuse. [53] In this 12-week, randomized, double-blind trial, topiramate significantly reduced the number of days with headache (p < 0.0001 vs placebo) and the mean amount of acute therapy consumed (p < 0.0001 vs placebo). [53] …”

Section: Costs Resource Use and Productivitymentioning

confidence: 97%

The Effect of Migraine Prophylaxis on Migraine-Related Resource Use and Productivity

Láinez

2009

CNS Drugs

View full text Add to dashboard Cite

In the US, it is estimated that up to 10% of men and 25% of women, particularly those aged 25-55 years, experience debilitating migraines, such that the condition presents an enormous economic burden for patients, health systems, employers and society. Migraine headache is a particularly prevalent condition associated with major reductions in patients' quality of life. From a payer perspective, the implementation of relevant programmes of migraine prophylaxis is highly desirable. Consistent evidence exists, from several randomized, controlled studies, of the efficacy of amitriptyline, divalproex sodium, propranolol, timolol and topiramate in migraine prophylaxis. Considering resource utilization, various studies suggest that migraine prophylaxis with antiepileptics, antidepressants, beta-blockers or calcium channel antagonists markedly reduces triptan use and visits to physician offices and emergency departments (EDs), without compromising quality of care or treatment outcomes. Over recent years, the effects of topiramate in reducing resource utilization in patients with migraine have been relatively widely studied. In US claims database analyses involving >4000 patients with migraine, topiramate significantly reduced triptan use by up to 20% in the 12-month period after starting treatment. Reductions were also noted in the numbers of ED visits, diagnostic procedures, hospital admissions and migraine-related hospitalization days. These long-term benefits of topiramate manifested without any increase in overall headache-related costs. Furthermore, in detailed modelling analyses based on UK and US data, topiramate-induced savings in acute medical services were estimated to offset about one-quarter of the monthly per patient cost of the topiramate regimen, which was shown to be a dominant cost-effective intervention relative to no preventive therapy: cost-effectiveness ratios were calculated as pound 5728 per quality-adjusted life-year (QALY) [2005 costings] and $US10 888 per QALY (2002 costings), respectively. Overall, there is a need to improve quality of care in migraine, and prophylactic therapy appears to be an effective option, particularly with respect to decreasing resource use and improving productivity. For both health-plan payers and employers, topiramate appears to be a cost-effective intervention for preventing migraine.

show abstract

“…Topiramate reduced migraine frequency in CM in some smaller clinical trials [17][18][19]. A pooled analysis performed by Limmroth et al [20] concluded that preventive treatment with topiramate in patients with episodic migraine may reduce the risk of developing chronic forms of headache.…”

Section: Topiramatementioning

confidence: 97%

Treatment of Chronic Migraine

Diener

Holle

Dodick

2010

Curr Pain Headache Rep

View full text Add to dashboard Cite

Chronic migraine is defined in different ways. The most commonly used definition is headache on more than 15 days per month in patients with migraine. Chronic migraine is difficult to treat and requires a multidisciplinary approach. Only two pharmacological treatments have been shown to be effective in placebo-controlled randomized trials: topiramate and local injection of botulinum toxin. Both therapies are effective in patients with chronic migraine with and without medication overuse. Many other substances have been investigated in chronic daily headache. All trials were underpowered and, therefore, recommendations concerning possible efficacy are not possible.

show abstract

Topiramate and Triptans Revert Chronic Migraine With Medication Overuse to Episodic Migraine

Abstract: Topiramate proved to be well tolerated and effective in reverting chronic migraine with medication overuse to episodic migraine.

Cited by 72 publications

References 12 publications

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

The Effect of Migraine Prophylaxis on Migraine-Related Resource Use and Productivity

Treatment of Chronic Migraine

Contact Info

Product

Resources

About