Topiramate in Migraine Prevention

Abstract

Migraine is one of the most frequent forms of headache. It is estimated that 6-8% of all men and 12-14% of all women suffer from migraine. [1][2][3][4] The lifetime-prevalence in women is >25%. Before puberty the frequency of migraine is 4-5%. Boys and girls are affected equally. The highest incidence of migraine attacks occurs between the 35th and 45th years of life. During this phase of life women are affected three times more frequently than men. Migraine attacks lead to severe, frequently unilateral pulsating and pounding headaches, increasing with physical activity. 5 This can lead to a severe disruption in quality of life and the World Health Organization (WHO) has rated migraine as one of the top 20 leading causes of disability worldwide. 6 The individual attacks are accompanied by a loss of appetite (almost always), nausea (80%), vomiting (40-50%), light sensitivity (photophobia 60%) noise sensitivity (phonophobia 50%) and odour hypersensitivity (10%). If the headaches are unilateral they can change sides within an attack or from attack to attack. The duration of the attacks, depending on the definition of the International Headache Society, varies between four and 72 hours. 5 In children the attacks are shorter and can also occur without headaches, and with only severe nausea, vomiting and giddiness. 6 M i g r a i n e P r o p h y l a x i sThe pharmacological treatment of acute migraine attacks is based on the 5-HT1B/1D agonists (triptans), non-opioid analgesics and non-steroidal antiinflammatory drugs (NSAIDs). If the patient suffers from three or more migraine attacks per month, migraine attacks regularly last longer than 72 hours and if the attack frequency increases and the intake of analgesics or antimigraine agents occurs on more than 10 days per month, then prophylactic treatment is recommended. Pharmacological prophylaxis is also indicated for migraine attacks that do not respond to acute therapy or if side effects render acute therapy intolerable.The aim of prophylaxis is to reduce the frequency, severity and duration of migraine attacks and to prevent the development of medication overuse. Migraine prophylaxis is considered effective if headache frequency is reduced by at least 50%. P h a r m a c o l o g i c a l P r o p h y l a x i s o f C h r o n i c M i g r a i n eIn Europe, beta-blockers (e.g. propranolol and metoprolol) are the most widely prescribed drugs for the prevention of migraine. Although the anti-epileptic drug (AED) sodium valproate has also been widely used in an off-label setting for migraine prophylaxis, the approval of topiramate represented the first AED to be indicated for migraine prevention. The tricyclic antidepressant amitriptyline, the calcium channel blocker flunarizine and the serotonin antagonist methysergide have also been used in the prophylaxis setting. Despite evidence of efficacy, the mechanism or site of action of these drugs is uncertain. Cortical spreading depression (CSD) has been implicated in migraine and as a headache trigger. In experimental animals CSD ...

Preventive Agents for Migraine: Focus on the Antiepileptic Drugs

“…Only 15%–20% of all patients that fulfill the criteria for migraine prophylaxis treatment receive the appropriate treatment 71. The side-effects, compliance, and cost of prolonged treatment are important limiting factors.…”

“…Only 15%-20% of all patients that fulfill the criteria for migraine prophylaxis treatment receive the appropriate treatment. 71 The side-effects, compliance, and cost of prolonged treatment are important limiting factors. Physicians should therefore be aware that treatment strategies for migraine prophylaxis require patient understanding and acceptance.…”

Neurosarcoidose: Relato De Caso Em Paciente Com Rebaixamento Do Sensório Associado a Neuropatia De Nervo Craniano, Cefaleia E Vasculopatia

“…Migraine prophylaxis main goal is the reduction of its frequency, severity, duration of the "attacks" and the prevention concerning the use of high doses of abortive drugs. Migraine prophylaxis is considered effective in case of reduction in at last 50% of the frequency of the "attacks" (Diener, 2007).…”