Utility of Topiramate for the Treatment of Patients with Chronic Migraine in the Presence or Absence of Acute Medication Overuse

Abstract

Chronic migraine has been linked to the excessive use of acute headache medications. Medication overuse (MO) is commonly considered the most significant risk factor for the progression of migraine from an episodic to a chronic condition. Managing MO is a challenge. Discontinuation of the acute medication can result in withdrawal headache, nausea, vomiting and sleep disturbances. This review summarizes the results from two similarly designed, randomized, placebo-controlled, multicentre studies of chronic migraine conducted in the USA and European Union. Both studies demonstrate the efficacy and safety of the migraine preventive medication, topiramate, for the treatment of chronic migraine in patient populations both with and without MO. These studies may have important implications for the future of chronic migraine management, suggesting that detoxification prior to initiating prophylactic therapy may not be required in all patients if MO is present.

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

“…The effect size was overall modest, however, with a mean reduction in monthly migraine days of 3.5 (versus placebo -0.2) and a numberneeded-to-treat of 12.5 [61]. Remarkably, the benefits of topiramate extended to the subgroup of patients who were overusing acute medications [62]. Topiramate use was also associated with a decreased number of monthly days of acute medication use (-3 days in the topiramate group versus -0.7 days in the placebo group), but this difference was not statistically significant.…”

Prednisone for the treatment of withdrawal headache in patients with medication overuse headache: A randomized, double-blind, placebo-controlled study

“…This was due to the awareness that prophylactics during overuse do not reduce headache frequency. Only recently it was shown that topiramate is effective even in patients overusing medication (16).…”

Chronic Daily Headache

“…6 Two larger, randomized, double-blind, placebo-controlled, parallel-group clinical trials were performed with topiramate in patients with CM. Significant reduction in the mean monthly rate of migraine/migrainous days (6.4 Ϯ 5.8) compared to placebo (4.7 Ϯ 6.1; p ϭ 0.010) and a mean reduction from baseline of migraine days per month (5.6 Ϯ 6.0) compared to placebo (4.1 Ϯ 6.1; p ϭ 0.032) was observed in the United States, 7 whereas reduction in mean monthly migraine days (Ϫ3.5 Ϯ 6.3) was noted compared to placebo (0.2 Ϯ 4.7 p ϭ 0.02) in a study conducted in the European Union. In this study, patients with acute MO reported mean monthly reduction in migraine days by 3.5 Ϯ 7.1 days, which was significant compared to placebo with an increase of 0.8 Ϯ 4.8 days ( p ϭ 0.03).…”