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Efficacy of Topiramate in Migraine Prophylaxis: A Retrospective Chart Analysis


Randal L. Von Seggern, Pharm. D., Headache Wellness Center, 301 East Wendover Avenue, Suite 411, Greensboro, NC 27401.


Objective.— Topiramate, a broad-spectrum anticonvulsant with multiple mechanisms of action, may be effective in preventing migraine headaches. We report the results of a retrospective chart review of patients treated with topiramate for prophylaxis of migraine.

Methods.—Patients with a diagnosis of migraine who had at least one follow-up visit after geqslant R: gt-or-equal, slanted4 weeks on topiramate were eligible; 69 patients (56 women and 13 men) aged 18 to 68 years met these criteria. Charts were reviewed for frequency of mild or moderate/severe headaches at the start of topiramate (baseline) and at all subsequent visits up to 24 weeks.

Results.—The 28-day frequency of moderate/severe migraines declined significantly from baseline to end of treatment (10.6 ± 8.4 to 7.4 ± 7.7, respectively; P = 0.0004), whereas that of mild headaches did not demonstrate a significant change (from 11.8 ± 8.9 to 11.0 ± 10.0). Among the 38 patients who had not responded previously to geqslant R: gt-or-equal, slanted9 preventive medications, the monthly frequency of moderate/severe (but not mild) headaches decreased significantly from baseline to end of treatment. Patients who previously had not responded to <9 prior medications experienced significant declines in both mild and moderate/severe headaches. The most common adverse events were paresthesias, drowsiness, diarrhea, decreased appetite, and weight loss. Twenty-seven patients discontinued topiramate therapy, 20 as a result of adverse events and 7 due to lack of response.

Conclusion.—Topiramate may be effective in reducing the frequency of both mild and moderate/severe migraine headaches. In particular, topiramate may offer relief to patients with moderate/severe migraines who do not respond to other treatments.