Topiramate in Patients With Episodic Migraine: Reducing the Risk for Chronic Forms of Headache

Abstract

Preventive treatment with topiramate in patients with episodic migraine may reduce the risk of developing chronic forms of headache.

Topiramate intervention to prevent transformation of episodic migraine: The topiramate INTREPID study

“…The study failed to demonstrate that topiramate treatment prevented the transformation of episodic migraine to CDH in contradistinction to clinical observations and a post hoc clinical trial analysis (23). There are several possible explanations for this failure.…”

Clinical pharmacology of topiramate in migraine prevention

“…Moreover, the number of daily use of acute medication was significantly reduced in the topiramate group versus placebo (p < 0.001) [46]. Because the use of acute medication, as well as the frequency of attacks, is a risk factor for progression [4], the authors concluded that preventive treatment with topiramate in patients with episodic migraine could reduce the risk of developing chronic migraine [46]. However, a multicenter RCT including 159 patients who suffered from migraine with high frequency (9 --14 migraine headache days/month) showed that topiramate 100 mg/day did not decrease significantly the development of chronic daily headache at 6 months compared to placebo, although significantly reducing the frequency of migraine and headache days [47].…”

“…It emerged that significantly fewer patients who received topiramate reported an increase in headache days/month than patients treated with placebo (p < 0.05). Moreover, the number of daily use of acute medication was significantly reduced in the topiramate group versus placebo (p < 0.001) [46]. Because the use of acute medication, as well as the frequency of attacks, is a risk factor for progression [4], the authors concluded that preventive treatment with topiramate in patients with episodic migraine could reduce the risk of developing chronic migraine [46].…”

Treatment of Chronic Migraine

“…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.…”