Topiramate migraine

Only propranolol, timolol, valproic acid, and topiramate are approved by the FDA for migraine prevention. 

Topiramate is recently approved by the FDA for migraine prophylaxis. Dose is initiated at 25 mg/day and increased slowly to minimize side effects, which may include paresthesias, fatigue, anorexia, diarrhea, weight loss, difficulty with memory, and nausea. Kidney stones, acute myopia, acute angle-closure glaucoma, and oligohidrosis have been infrequently reported. 

Propranolol, amitriptyline, and some calcium channel blockers have been found to be effective for the prophylaxis of migraine in some patients. They are of no value in the treatment of acute migraine. The anticonvulsants valproic acid and topiramate (see Chapter 24) have... 

Topiramate is an antiepileptic medication also used in an off-label capacity to treat migraine headaches and bipolar disorders. 

Ptacek That is thought to be the case. It isn t clear, however, whether it is through action on the Na+ channel itself. In muscle CLCl in the Cl channel is extremely sensitive to pH. It could be acting on some other channel, but many people think it is pH. Supporting this in the more generali2ed way is the fact that carbonic anhydrase inhibitors help some patients with migraine. Topiramate has some carbonic anhydrase inhibition properties, although it is not clear that these play any role in its anticonvulsant effects. 

Brandes JL, Saper JR, Diamond M, et al. Topiramate for migraine prevention A randomized controlled trial. JAMA 2004 291 965-973. 

Topiramate is an anticonvnlsant that blocks repetitively elicited action potentials, affects the ability of chloride ion to move into nenrons, and antagonizes an excitatory amino acid receptor. It is indicated as an adjunctive therapy for partial onset seiznres primary generalized tonic-clonic sei-znres seiznres associated with Lennox-Gastaut syndrome and prophylaxis of migraine headache. 

Topiramate is a sulfamate-substituted monosaccharide derived from fructose with a broad spectrum of AED activity. It is approved for monotherapy or as an adjunct drug for partial or primary generalized tonic-clonic seizures in patients older than 10 years, as adjunct therapy in children aged from 2 to 10 years with partial-onset seizures, and in persons older than 2 years with Lennox-Gastaut syndrome (40,53). Topiramate also is approved for the prophylaxis of migraine headaches. 

Commonly prescribed medications to prevent migraines are amitriptyline, divaproex sodium, propranol, timolol, topiramate, bupropion, cyproheptadine, diltiazem, doxepin, fluvoxamine, ibuprofen, imipramine, and methysergide. Methysergide is particularly effective. However, there are side effects that might make this dmg less tolerable. 

In 40 selected patients, age range 18-64 years, who were randomized in an open study for migraine prophylaxis to topiramate 25, 50, 75 or 100 mg as an evening dose paresthesia was by far the most common adverse reaction (55% of patients) and the incidence was dose related [280. Fatigue, giddiness, diarrhea, nausea, and drowsiness were reported in a few patients, but there was no apparent dose-effect relation. 

In an open study of topiramate 50 or 100 mg/day in 30 patients with migrainous vertigo, 19 had paresthesia, 11 fatigue, 8 memory and concentration problems, 14 reduced appetite, and 4 weight loss [281 ]. Four withdrew at the end of the first month because of adverse reactions. 

Ear, nose, throat In three cases prophylactic treatment for migraine with topiramate was withdrawn because of primary intractable coughing [288 ]. 

Nervous system In a review of several clinical studies of the use of topiramate in different indications (alcohol dependence, essential tremor, binge-eating disorder, bulimia nervosa, migraine, and epilepsy), the percentages of drug-induced nervous system adverse reactions, in particular paresthesia, differed greatly between the different disorders dropouts due to adverse events varied from 2% in those with bulimia nervosa to 29% in those with migraine [289 ]. 

Myoclonus and acute psychosis have been reported in a 29-year-old woman taking topiramate in the dosage recommended for migraine prophylaxis [290 ]. 

A 68-year-old woman developed bilateral acute glaucoma after taking topiramate for migraine prophylaxis [292 ]. 

Psychological In a randomized, doubleblind, placebo-controlled, multicenter study of the prevention of attacks of migraine, 103 adolescents (aged 12 through 17 years) were randomized to topiramate 50 mg/day... 

Sweat glands Hypohidrosis and hyperthermia are uncommon adverse reactions to topiramate and usually occur in children with epilepsy. Reversible hypohidrosis has been reported in an adult taking topiramate for chronic migraine [297 ]. 

Lo YL, Lum SY, Fook-Chong S, Siow HC. A pilot study of topiramate dosages for migraine prophylaxis in an Asian population. J Headache Pain 2010 11(2) 175-8. 

Maggioni F, Mampreso E, Mainardi F, Lisotto C, Malvindi ML, Zanchin G. Topiramate-induced intractable cough during migraine prophylaxis. Headache 2010 50(2) 301. ... 

Miller AD, Prost VM, Bookstaver PB, Gaines KJ. Topiramate-induced myoclonus and psychosis during migraine prophylaxis. Am J Health Syst Pharm 2010 67 (14) 1178-80. 

Pandina GJ, Ness S, Polverejan E, Yuen E, Eerdekens M, Bilder RM, Ford L. Cognitive effects of topiramate in migraine patients aged 12 through 17 years. Pediatr Neurol 2010 42(3) 187-95. 

Markowitz SY, Robbins MS, Cascella C, Sheikh HU, Grosberg BM. Reversible hypo-hidrosis with topiramate therapy for chronic migraine. Headache 2010 50(4) 672-4. 

Comparative studies In a 26-week, multicenter, randomized, double-blind, doubledummy, parallel-group non-inferiority comparison of topiramate and amitriptyline in the prophylaxis of episodic migraine in 331 subjects (172 topiramate, 159 amitriptyline) there were no significant differences between the groups in any of the outcome measures [295 ]. There were treatment-... 

In a single-center, 8-week titration and 4-week maintenance period, double-blind, randomized study of topiramate or amitriptyline, alone or in combination, in 73 patients with migraine with or without aura all the treatments resulted in significant improvements in all efficacy measures [296 ]. Discontinuation rates due to adverse events were 8.3%, 14%, and 4.3% with topiramate, amitriptyline, and the combination respectively. The most common adverse effects in the topiramate group were paresthesia (35% at 8 weeks and 40% at 12 weeks), weight loss (25% and 35% respectively), and memory impairment (10% and 15%, respectively). 

In 62 patients who were randomized to low-dose topiramate or propranolol for migraine prophylaxis in a randomized, 8-week, double-blind trial both drugs significantly reduced the frequency, intensity. 

A comparison of adverse drug reactions to topiramate in different diseases has been systematically reviewed pOl ]. All published randomized controlled trials that compared topiramate monotherapy with other drugs in epilepsy emd migraine were analysed. Four... 

Nervous system A woman with familial hemiplegic migraine experienced worsening of her symptoms after repeated doses of topiramate [303 ]. 

In an open, prospective study of 35 patients with migraine aged over 18 years topiramate was started at 25 mg/day and increased by 25 mg/day each week, until the maximum dose of 50 mg bd was reached in the fourth week [311 ]. Only 22 patients completed the 3-month study. Although 41% complained of cognitive... 

Psychiatric A patient with migraine developed reversible, dose-related, auditory hallucinations during topiramate therapy [313 ]. 

---