Topiramate in the Treatment of Chronic Migraine

Silvestrini, Mauro; Bartolini, Marco; Coccia, Michela; Baruffaldi, Roberto; Taffi, Ruja; Provinciali, Leandro

doi:10.1046/j.1468-2982.2003.00592.x

Cited by 146 publications

(122 citation statements)

References 22 publications

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“…These chronic migraine patients have been shown to respond satisfactorily to topiramate [7,8], even in the presence of overuse and in controlled conditions [9,10]. Interestingly, among the group of responders in long-term treatment there was only one patient whose headaches became worse while on topiramate.…”

Section: Discussionmentioning

confidence: 99%

How many migraine patients need prolonged (>1 year) preventive treatment? Experience with topiramate

2007

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The usual recommended duration of preventive treatment for migraine is 3-6 months. Our aim was to explore how many patients attending a specialised clinic need prolonged preventive treatment for longer than one year. Eighty consecutive migraine patients who received preventive treatment with topiramate for 3 months with good response and tolerability were included in this observational study. All patients continued on topiramate until they had completed 6 months, when this drug was stopped. Topiramate was reintroduced if there was a worsening. Topiramate was kept for 6 more months and then discontinued again. Those patients whose headaches became worse after this second withdrawal received topiramate again and were followed-up for at least half a year. Headaches did not worsen after the first withdrawal at 6 months in 40 patients (50%), while they clearly worsened in the remaining 40 patients. At the end of the first year only two patients out of these 40 (5%) discontinued topiramate and did not notice an increase in headache frequency after two months. In conclusion, around half of the patients attending a specialised clinic due to frequent headache need preventive treatment for more than one year. Our data suggest that the current practice recommending periods of preventive treatment of 3-6 months should be reconsidered for many patients.

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Section: Discussionmentioning

confidence: 99%

How many migraine patients need prolonged (>1 year) preventive treatment? Experience with topiramate

2007

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“…Silvestrini et al [7] showed the efficacy of topiramate in chronic migraine with analgesic overuse preventive treatment. Only 28 patients were studied receiving topiramate in a lower dose (50 mg).…”

Section: Discussionmentioning

confidence: 99%

Chronic migraine prevention with topiramate

et al. 2006

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Chronic migraine (CM) is a disabling condition with not many treatment strategies available. Topiramate is effective in episodic migraine prevention, however little is known about its effect in CM. An open label study was performed. Sixty-four patients diagnosed with CM or probable CM according to the IHS diagnostic criteria were enrolled, 50 patients were available for analysis and an intention-to-treat methodology was applied. The primary endpoint considered was the number of patients with a decrease in headache frequency higher than 50%. The median dose was 100 mg, a reduction in frequency higher than 50% occurred in 33 patients (66%) and 14 (28%) presented a complete response, defined as a frequency reduction higher than 95%. The medication was well tolerated. The most common side effects found were weight loss, paraesthesias, nausea, cognitive dysfunction, fatigue, somnolence, insomnia and depression. Our findings suggest that topiramate is effective in CM prophylaxis.

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“…The encouraging results from a small randomized, placebo-controlled trial (RCT) of topiramate (50 mg daily) in 28 patients with CM and medication overuse paved the way for larger studies [58]. Two multicentre, parallel-group RCT in Europe (59 patients) and the USA (328 patients) showed that topiramate at a daily dose of 100 mg during 16 weeks was effective as a preventive therapy for CM [59,60].…”

Section: Topiramatementioning

confidence: 99%

Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society

Paemeleire

Louis²,

Magis

et al. 2014

Acta Neurol Belg

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Chronic migraine (CM) is a disabling neurological condition affecting 0.5-2 % of the population. In the current third edition of the International Classification of Headache Disorders, medication overuse is no longer an exclusion criterion and CM is diagnosed in patients suffering from at least 15 headache days per month of which at least eight are related to migraine. CM is difficult to treat, and preventive treatment options are limited. We provide a pathogenetic model for CM, integrating the latest findings from neurophysiological and neuroimaging studies. On behalf of the Belgian Headache Society, we present a management algorithm for CM based on the international literature and adapted to the Belgian situation. Pharmacological treatment options are discussed, and recent data on transcranial and invasive neuromodulation studies in CM are reviewed. An integrated multimodal treatment programme may be beneficial to refractory patients, but at present, this approach is only supported by a limited number of observational studies and quite variable between centres

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Topiramate in the Treatment of Chronic Migraine

Cited by 146 publications

References 22 publications

How many migraine patients need prolonged (>1 year) preventive treatment? Experience with topiramate

How many migraine patients need prolonged (>1 year) preventive treatment? Experience with topiramate

Chronic migraine prevention with topiramate

Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society

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