Topiramate in Migraine Prevention
Topiramate in Migraine Prevention
European Neurological Disease 2006 Issue 2
Published: October 2008
Published: October 2008
A report by Hans-Christoph Diener Chairman and Professor, Department of Neurology, University of Essen, Germany Migraine is one of the most frequent forms of headache. It is estimated that 6–8% of all men and 12–14% of all women suffer from migraine.1-4 The lifetime-prevalence in women is >25%. Before puberty the frequency of migraine is 4–5%. Boys and girls are affected equally. The highest incidence of migraine attacks occurs between the 35th and 45th years of life. During this phase of life women are affected three times more frequently than men.
Migraine attacks lead to severe, frequently unilateral pulsating and pounding headaches, increasing with physical activity.5 This can lead to a severe disruption in quality of life and the World Health Organization (WHO) has rated migraine as one of the top 20 leading causes of disability worldwide.6 The individual attacks are accompanied by a loss of appetite (almost always), nausea (80%), vomiting (40–50%), light sensitivity (photophobia 60%) noise sensitivity (phonophobia 50%) and odour hypersensitivity (10%). If the headaches are unilateral they can change sides within an attack or from attack to attack. The duration of the attacks, depending on the definition of the International Headache Society, varies between four and 72 hours.5 In children the attacks are shorter and can also occur without headaches, and with only severe nausea, vomiting and giddiness.6
Migraine Prophylaxis
The pharmacological treatment of acute migraine attacks is based on the 5-HT1B/1D agonists (triptans), non-opioid analgesics and non-steroidal antiinflammatory drugs (NSAIDs). If the patient suffers from three or more migraine attacks per month, migraine attacks regularly last longer than 72 hours and if the attack frequency increases and the intake of analgesics or antimigraine agents occurs on more than 10 days per month, then prophylactic treatment is recommended. Pharmacological prophylaxis is also indicated for migraine attacks that do not respond to acute therapy or if side effects render acute therapy intolerable.
The aim of prophylaxis is to reduce the frequency, severity and duration of migraine attacks and to prevent the development of medication overuse. Migraine prophylaxis is considered effective if headache frequency is reduced by at least 50%.
Pharmacological Prophylaxis of Chronic Migraine
In Europe, beta-blockers (e.g. propranolol and metoprolol) are the most widely prescribed drugs for the prevention of migraine. Although the anti-epileptic drug (AED) sodium valproate has also been widely used in an off-label setting for migraine prophylaxis, the approval of topiramate represented the first AED to be indicated for migraine prevention. The tricyclic antidepressant amitriptyline, the calcium channel blocker flunarizine and the serotonin antagonist methysergide have also been used in the prophylaxis setting. Despite evidence of efficacy, the mechanism or site of action of these drugs is uncertain. Cortical spreading depression (CSD) has been implicated in migraine and as a headache trigger. In experimental animals CSD can be evoked by electrical or chemical stimulation. A recent study in the rat model suggests that CSD provides a common therapeutic target for migraine prophylactic drugs.7 In the study, rats were treated either acutely or chronically over weeks and months, with either topiramate, sodium valproate, propranolol, amitriptyline, methysergide, vehicle or D-propranolol, a clinically ineffective drug. The impact of treatment was determined on the frequency of evoked CSDs after topical potassium application or on the incremental cathodal stimulation threshold to evoke CSD. Chronic daily administration of migraine prophylactic drugs dose dependently suppressed CSD frequency by 40–80% and increased the cathodal stimulation threshold. Importantly, acute treatment was ineffective.
Currently, the recommended first-line agents for migraine prophylaxis include the beta-blockers metoprolol and propranolol, the calcium antagonist flunarizine and the AED topiramate.
References:
1. Lipton R, Scher A, Kolodner K et al., - Migraine in the United States: epidemiology and patterns of health care use; , Neurology (2002);58(6): pp. 885 894.
2. Rasmussen BK, Jensen R, Schroll M et al., - Epidemiology of headache in a general population a prevalence study; , J Clin Epidemiol (1991);44: pp. 1147 1157.
3. Scher A, Stewart WF, Liberman J et al, - Prevalence of frequent headache in a population sample; , Headache (1998);38: pp. 497 506.
4. Silberstein SD, Lipton RB, - Headache epidemiology. Emphasis on migraine; , Neurological Clinics (1996);14: pp. 421 434.
5. Olesen J, Bousser M-G, Diener H et al., - The International Classification of Headache Disorders. 2nd Edition; , Cephalalgia (2004);24(Suppl. 1): pp. 1 160.
6. Maytal J, Young M, Shechter A et al., - Pediatric migraine and the International Headache Society (IHS) criteria; , Neurology (1997);48: pp. 602 607.
7. Ayata C, Jin H, Kudo C, Dalkara T et al., - Suppression of cortical spreading depression in migraine prophylaxis; , Ann Neurol (2006);59(4): pp. 652 661.
8. Diamond S, Medina JL, - Double blind study of propranolol for migraine prophylaxis; , Headache (1976);16: pp. 24 27.
9. Gawel MJ, Kreeft J, Nelson RF et al., - Comparison of the efficacy and safety of flunarizine to propranolol in the prophylaxis of migraine; , Can J Neurol Sci (1992);19: pp. 340 345.
10. Havanka-Kanniainen H, Hokkanen E, Myllylä VV, - Long acting propranolol in the prophylaxis of migraine. Comparison of the daily doses of 80mg and 160mg; , Headache (1988);28: pp. 607 611.
11. Holroyd KA, Penzien DB, Cordingley GE, - Propranolol in the management of recurrent migraine: a meta-analytic review; , Headache (1991);31: pp. 333 340.
12. Kangasniemi P, Hedman C, - Metoprolol and propranolol in the prophylactic treatment of classical and common migraine. A double-blind study; , Cephalalgia (1984);4: pp. 91 96.
13. Olsson JE, Behring HC, Forssman B et al., - Metoprolol and propranolol in migraine prophylaxis: a double-blind multicenter study; , Acta Neurol Scand (1984);70: pp. 160 168.
14. Tfelt-Hansen P, Welch KM, - Prioritizing prophylactic treatment of migraine; , The Headaches 2nd edition (2000), Lippincott Williams & Wilkins; pp. 499 500.
15. Amery WK, Caers LI, Aerts TJL, - Flunarizine, a calcium entry blocker in migraine prophylaxis; , Headache (1985);25: pp. 249 254.
16. Balkan S, Aktekin B, Önal Z, - Efficacy of flunarizine in the prophylactic treatment of migraine; , Gazi Medical Journal (1994);5: pp. 81 84.
17. Bassi P, Brunati L, Rapuzzi B et al., - Low dose flunarizine in the prophylaxis of migraine; , Headache (1992);32:pp. 390 392.
18. Freitag F, Collins S, Carlson H et al., - A randomized trial of divalproex sodium extended-release tablets in migraine prophylaxis; , Neurology (2002);58: pp. 1652 1659.
19. Kaniecki RG, - A comparison of divalproex with propranolol and placebo for the prophylaxis of migraine without aura; , Arch Neurol (1997);54: pp. 1141 1145.
20. Silberstein SD, Collins SD, - Safety of divalproex sodium in migraine prophylaxis: an open-label, long-term study. Longterm Safety of Depakote in Headache Prophylaxis Study Group; , Headache (1999);39(9): pp. 633 643.
21. Brandes J, Saper J, Diamond M et al., - Topiramate for migraine prevention: a randomized controlled trial; , JAMA (2004);291: pp. 965 973.
22. Diener H, Tfelt-Hansen P, Dahlöf C et al., - Topiramate in migraine prophylaxis: results from a placebo-controlled trial with propranolol as an active control; , J Neurol (2004);251(8): pp. 943 950.
23. Silberstein SD, Neto W, Schmitt J et al., - Topiramate in migraine prevention: results of a large controlled trial; , Arch Neurol (2004);61: pp. 490 495.
24. H.C. Diener et al., - Long-term effectiveness of topiramate for migraine prevention: analyses of open-label extension-phase data from two pivotal studies; , EFNS Congress, Athens, (2005): Poster P2138.
25. D Amico D, Grazzi L, Usai S et al., - Topiramate in migraine prophylaxis; , Neurol Sci (2005);26(Suppl. 2):
2. Rasmussen BK, Jensen R, Schroll M et al., - Epidemiology of headache in a general population a prevalence study; , J Clin Epidemiol (1991);44: pp. 1147 1157.
3. Scher A, Stewart WF, Liberman J et al, - Prevalence of frequent headache in a population sample; , Headache (1998);38: pp. 497 506.
4. Silberstein SD, Lipton RB, - Headache epidemiology. Emphasis on migraine; , Neurological Clinics (1996);14: pp. 421 434.
5. Olesen J, Bousser M-G, Diener H et al., - The International Classification of Headache Disorders. 2nd Edition; , Cephalalgia (2004);24(Suppl. 1): pp. 1 160.
6. Maytal J, Young M, Shechter A et al., - Pediatric migraine and the International Headache Society (IHS) criteria; , Neurology (1997);48: pp. 602 607.
7. Ayata C, Jin H, Kudo C, Dalkara T et al., - Suppression of cortical spreading depression in migraine prophylaxis; , Ann Neurol (2006);59(4): pp. 652 661.
8. Diamond S, Medina JL, - Double blind study of propranolol for migraine prophylaxis; , Headache (1976);16: pp. 24 27.
9. Gawel MJ, Kreeft J, Nelson RF et al., - Comparison of the efficacy and safety of flunarizine to propranolol in the prophylaxis of migraine; , Can J Neurol Sci (1992);19: pp. 340 345.
10. Havanka-Kanniainen H, Hokkanen E, Myllylä VV, - Long acting propranolol in the prophylaxis of migraine. Comparison of the daily doses of 80mg and 160mg; , Headache (1988);28: pp. 607 611.
11. Holroyd KA, Penzien DB, Cordingley GE, - Propranolol in the management of recurrent migraine: a meta-analytic review; , Headache (1991);31: pp. 333 340.
12. Kangasniemi P, Hedman C, - Metoprolol and propranolol in the prophylactic treatment of classical and common migraine. A double-blind study; , Cephalalgia (1984);4: pp. 91 96.
13. Olsson JE, Behring HC, Forssman B et al., - Metoprolol and propranolol in migraine prophylaxis: a double-blind multicenter study; , Acta Neurol Scand (1984);70: pp. 160 168.
14. Tfelt-Hansen P, Welch KM, - Prioritizing prophylactic treatment of migraine; , The Headaches 2nd edition (2000), Lippincott Williams & Wilkins; pp. 499 500.
15. Amery WK, Caers LI, Aerts TJL, - Flunarizine, a calcium entry blocker in migraine prophylaxis; , Headache (1985);25: pp. 249 254.
16. Balkan S, Aktekin B, Önal Z, - Efficacy of flunarizine in the prophylactic treatment of migraine; , Gazi Medical Journal (1994);5: pp. 81 84.
17. Bassi P, Brunati L, Rapuzzi B et al., - Low dose flunarizine in the prophylaxis of migraine; , Headache (1992);32:pp. 390 392.
18. Freitag F, Collins S, Carlson H et al., - A randomized trial of divalproex sodium extended-release tablets in migraine prophylaxis; , Neurology (2002);58: pp. 1652 1659.
19. Kaniecki RG, - A comparison of divalproex with propranolol and placebo for the prophylaxis of migraine without aura; , Arch Neurol (1997);54: pp. 1141 1145.
20. Silberstein SD, Collins SD, - Safety of divalproex sodium in migraine prophylaxis: an open-label, long-term study. Longterm Safety of Depakote in Headache Prophylaxis Study Group; , Headache (1999);39(9): pp. 633 643.
21. Brandes J, Saper J, Diamond M et al., - Topiramate for migraine prevention: a randomized controlled trial; , JAMA (2004);291: pp. 965 973.
22. Diener H, Tfelt-Hansen P, Dahlöf C et al., - Topiramate in migraine prophylaxis: results from a placebo-controlled trial with propranolol as an active control; , J Neurol (2004);251(8): pp. 943 950.
23. Silberstein SD, Neto W, Schmitt J et al., - Topiramate in migraine prevention: results of a large controlled trial; , Arch Neurol (2004);61: pp. 490 495.
24. H.C. Diener et al., - Long-term effectiveness of topiramate for migraine prevention: analyses of open-label extension-phase data from two pivotal studies; , EFNS Congress, Athens, (2005): Poster P2138.
25. D Amico D, Grazzi L, Usai S et al., - Topiramate in migraine prophylaxis; , Neurol Sci (2005);26(Suppl. 2):
