Current affiliation: Ethicon, Inc., Somerville, NJ, USA.
Electronic Medical Records as a Research Tool: Evaluating Topiramate Use at a Headache Center
Article first published online: 4 MAR 2010
© 2010 the Authors. Journal compilation © 2010 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 50, Issue 5, pages 769–778, May 2010
How to Cite
Marmura, M. J., Hopkins, M., Andrel, J., Young, W. B., Biondi, D. M., Rupnow, M. F.T. and Armstrong, R. B. (2010), Electronic Medical Records as a Research Tool: Evaluating Topiramate Use at a Headache Center. Headache: The Journal of Head and Face Pain, 50: 769–778. doi: 10.1111/j.1526-4610.2010.01624.x
Conflict of Interest: Mary Hopkins and Jocelyn Andrel report no conflicts of interest. Dr. Marmura is a member of the speaker's bureau for Cephalon and received research or education grants from Merck and GlaxoSmithKline. Dr. Young has been an advisor and a member of the speaker's bureau for Allergan, GlaxoSmithKline, Merck, Ortho-McNeil Janssen, Valeant, and received research or education grants from AGA Medical, Advanced Bionics, Advanced Neuromodulation Systems, Allergan, Capnia, Eli Lilly, Endo Pharmaceuticals, GlaxoSmithKline, Medtronic, Merck, Minster, and Valeant. Dr. Rupnow was an employee of Ortho-McNeil Janssen Scientific Affairs, LLC, a Johnson & Johnson company, at the time of manuscript development. Dr. Biondi and Dr. Armstrong are employees of Ortho-McNeil Janssen Scientific Affairs, LLC, a Johnson & Johnson company. Jocelyn Andrel (Thomas Jefferson University) conducted the statistical analyses.
- Issue published online: 23 APR 2010
- Article first published online: 4 MAR 2010
- Accepted for publication January 14, 2010.
- chronic migraine;
- electronic medical records
Background.— Electronic medical records (EMRs) are used in large healthcare centers to increase efficiency and accuracy of documentation. These databases may be utilized for clinical research or to describe clinical practices such as medication usage.
Methods.— We conducted a retrospective analysis of EMR data from a headache clinic to evaluate clinician prescription use and dosing patterns of topiramate. The study cohort comprised 4833 unique de-identified records, which were used to determine topiramate dose and persistence of treatment.
Results.— Within the cohort, migraine was the most common headache diagnosis (n = 3753, 77.7%), followed by tension-type headache (n = 338, 7.0%) and cluster or trigeminal autonomic cephalalgias (n = 287, 5.9%). Physicians prescribed topiramate more often for subjects with migraine and idiopathic intracranial hypertension (P < .0001) than for those with other conditions, and more often for subjects with coexisting conditions including obesity, bipolar disorder, and depression. The most common maintenance dose of topiramate was 100 mg/day; however, approximately 15% of subjects received either less than 100 mg/day or more than 200 mg/day. More than a third of subjects were prescribed topiramate for more than 1 year, and subjects with a diagnosis of migraine were prescribed topiramate for a longer period of time than those without migraine.
Conclusions.— Findings from our study using EMR demonstrate that physicians use topiramate at many different doses and for many off-label indications. This analysis provided important insight into our patient populations and treatment patterns.