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Topiramate for the prophylaxis of episodic migraine in adults

Linde M, Mulleners WM, Chronicle EP, McCrory DC

This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2013, Issue 6

Topiramate for the prophylaxis of episodic migraine in adults (Review)
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

1002/14651858. to improve migraine-related quality of life. or both. Canisius Wilhelmina Ziekenhuis. Norwegian University of Science and Technology. Durham. . NC. Cochrane Database of Systematic Reviews 2013. Copyright © 2013 The Cochrane Collaboration. Citation: Linde M. Ltd. Durham. Palliative and Supportive Care Group. USA Contact address: Mattias Linde. Manoa. and previously updated (conclusions not changed) in 2007.[Intervention Review] Topiramate for the prophylaxis of episodic migraine in adults Mattias Linde1 . Norwegian University of Science and Technology. For headache frequency data. controlled trials of topiramate taken regularly to prevent the occurrence of migraine attacks. Ltd. Edward P Chronicle3 .5 1 Department of Neuroscience. This might be explained by the variety of actions of these drugs in the central nervous system. University of Hawaii at Manoa. published in Issue 6. Published by John Wiley & Sons. DOI: 10. Data collection and analysis Two review authors independently selected studies and extracted data. Editorial group: Cochrane Pain. We calculated MDs for selected quality of life instruments. No. ABSTRACT Background Some antiepileptic drugs but not others are useful in clinical practice for the prophylaxis of migraine. Durham Veterans Affairs Medical Center. Chronicle EP. PubMed/MEDLINE (1966 to 15 January 2013). Finally. Trondheim. 2013. Mulleners WM. The Cochrane Library 2012. 2 Department of Neurology. Wim M Mulleners2 . Issue 6. Topiramate for the prophylaxis of episodic migraine in adults. Objectives To describe and assess the evidence from controlled trials on the efficacy and tolerability of topiramate for preventing migraine attacks in adult patients with episodic migraine. or topiramate in a different dose) for individual studies and pooled these across studies. McCrory DC. Duke University Medical Center. mattias. Trondheim. Department of Neuroscience.CD010610. Norway. NC. Nijmegen. The present review is part of an update of a Cochrane review first published in 2004. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL. Norway. Topiramate for the prophylaxis of episodic migraine in adults (Review) Copyright © 2013 The Cochrane Collaboration. in select cases. Review content assessed as up-to-date: 15 January 2013. we calculated odds ratios (ORs) and. For dichotomous data on responders (patients with ≥ 50% reduction in headache frequency). Publication status and date: New. we summarised data on adverse events from placebo-controlled trials and calculated risk differences (RDs) and numbers needed to harm (NNHs).: CD010610. 4 Department of Medicine. Issue 12). risk ratios (RRs). we calculated mean differences (MDs) between topiramate and comparator (placebo. Selection criteria Studies were required to be prospective. 3 (Deceased) Department of Psychology. Art. MEDLINE In-Process (current week. USA. Netherlands. Published by John Wiley & Sons. active control. we also calculated numbers needed to treat (NNTs). 15 January 2013). 5 Center for Health Services Research in Primary Care. Douglas C McCrory4. and EMBASE (1974 to 15 January 2013) and handsearched Headache and Cephalalgia through January

More studies designed specifically to compare the efficacy or safety of topiramate versus other interventions with proven efficacy in the prophylaxis of migraine are needed.61 to 3. (d) no significant difference between topiramate and relaxation (one study. For the present review.2 per month (nine studies. 1737 participants). three studies.04. 2. (c) no significant difference between topiramate and propranolol (two studies. These were usually mild and of a non-serious nature. 804 participants). 95% CI 3 to 6). seven adverse events (AEs) were reported by at least three studies. 519 participants). NNT 4. 61 participants). 95% CI -1. Data from nine trials (1190 participants) show that topiramate approximately doubled the proportion of responders relative to placebo (RR 2.58 to -0. 852 participants).57 to 2. some of these drugs have also been used for preventing migraine attacks.15. This provides good evidence to support its use in routine clinical management. Meta-analysis of the three studies that included more than one dose of topiramate suggests that 200 mg is no more effective than 100 mg. or of the seven specific AEs. Published by John Wiley & Sons.49 (95% CI 2.36. with NNHs varying from 3 to 25. Topiramate for the prophylaxis of episodic migraine in adults (Review) Copyright © 2013 The Cochrane Collaboration. 520 participants).95. 95% confidence interval (CI) -1. between placebo and topiramate 50 mg.49 (95% CI 1.95 to 0. are used to treat epilepsy.71.2 attacks per 28 days as compared to placebo (MD -1. 3. Relaxation improved migraine-specific quality of life significantly more than topiramate. however. collectively termed ’antiepileptics’. for 100 mg.59 to -0. (b) no significant difference between topiramate and flunarizine (one study. Separate analysis of different topiramate doses produced similar MDs versus placebo at 50 mg (-0.Main results Twenty papers describing 17 unique trials met the inclusion criteria.53 to -0. 342 participants). . All three doses also significantly improved three or more domains of quality of life as compared to placebo. Ltd. Authors’ conclusions Meta-analysis demonstrates that topiramate in a 100 mg/day dosage is effective in reducing headache frequency and reasonably welltolerated in adult patients with episodic migraine.02. 95% CI -1. With regard to mean headache frequency and/or responder rate. All three doses significantly increased the proportion of responders relative to placebo. ORs were as follows: for 50 mg.20. cause birth defects and so should be used with caution in women of childbearing age. seven trials using active comparators found (a) no significant difference between topiramate and amitriptyline (one study. five studies. 1620 participants). six studies.80). 95% CI -1. 2. For several years. topiramate reduced the frequency of migraine headaches by approximately 1. and 200 mg (-0. Side effects associated with topiramate were common but generally mild. They examined research published up to 15 January 2013 and found 17 relevant studies. six studies. 1190 participants).44.23 to 5.87. AEs in general and all of the specific AEs except nausea were significantly more common on topiramate 100 mg than on placebo. topiramate can. Compared with placebo. but (e) a slight significant advantage of topiramate over valproate (two studies. 330 participants). In trials of topiramate against placebo. Except for taste disturbance and weight loss. 100 mg (-1.94. 95% CI 1.45. Further research is needed comparing topiramate with other active drugs used for preventing migraine attacks.60 to 3. five studies.35 (95% CI 1. three studies. PLAIN LANGUAGE SUMMARY Topiramate for preventing migraine attacks in adults Various medicines. Analysis of data from nine trials (1737 participants) showed that topiramate reduced headache frequency by about 1. there were no significant differences in the frequency of AEs in general.60. and for 200 mg. 120 participants). 83 participants). 1025 participants). and the RDs versus placebo were even higher for topiramate 200 mg. with NNHs varying from 2 to 17. researchers in The Cochrane Collaboration reviewed the evidence about the effects of topiramate in adult patients (≥ 16 years of age) with ’episodic’ migraine (headache on < 15 days per month). Patients were also about twice as likely to reduce the number of their migraine headaches by 50% or more with topiramate than with placebo (nine studies.