topiramate and Migraine-with-Aura

Preventive treatment with topiramate is effective for overall reduction of migraine frequency, but there are few data regarding its efficacy on perimenstrual migraines. To determine whether topiramate can prevent perimenstrual migraines, we analyzed data from premenopausal women as a subgroup of the Prolonged Migraine Prevention with Topiramate (PROMPT) study.. In total, 198 women from the PROMPT study with menstrually related migraine (MRM) were evaluated. After a one-to-two-month prospective baseline period, patients received open-label topiramate (50-200 mg/day) for six months.. During topiramate treatment, mean monthly migraine frequency was reduced from 7.03 at baseline to 4.36 (mean change: -2.66; p < .001, endpoint analysis). Mean percentage reductions were similar for migraines during and outside the perimenstrual period (-45.9% and -46.1%, respectively). In patients with aura, reductions in migraine days with (-48.3%) or without (-43.4%) aura were similar to those in patients without aura (-45.4%). Reductions were also similar whether women were taking combined oral contraceptives (-47.0%) or were not (-46.6%).. Topiramate reduces the frequency, but not severity or duration, of perimenstrual migraines in women with MRM, including migraines with and without aura, and regardless of combined oral contraceptive use.

Topics: Adult; Anticonvulsants; Contraceptives, Oral, Combined; Female; Fructose; Humans; Male; Menstruation Disturbances; Middle Aged; Migraine with Aura; Migraine without Aura; Prospective Studies; Severity of Illness Index; Topiramate; Treatment Outcome

Data from the Prolonged Migraine Prevention (PROMPT) with Topiramate trial were evaluated post hoc to determine whether topiramate could prevent migraine auras, and whether its efficacy in preventing migraine headaches was similar in patients with (MA; n = 269) and without (MoA; n = 542) aura. Migraines and auras were recorded during prospective baseline, 6-month open-label (OL) topiramate and 6-month double-blind (DB), placebo-controlled phases. In the last 28 OL days, migraines without aura and migraine auras decreased by 43.1% and 54.1%, respectively, in MA patients. MoA patients experienced a 44.3% reduction in migraines. In the DB phase, increases in migraines with placebo vs. topiramate were similar to the full study, but were generally not statistically significant, probably due to lack of power in the subgroup analysis. Similarly, there were no statistically significant changes in number of auras between groups. Thus, topiramate appears to reduce migraine auras in parallel with headache reductions, which are similar in patients with and without aura.

Topics: Adolescent; Adult; Aged; Double-Blind Method; Female; Fructose; Humans; Male; Middle Aged; Migraine Disorders; Migraine with Aura; Neuroprotective Agents; Topiramate; Treatment Outcome; Young Adult

Several large, randomized, double-blind, placebo-controlled trials have found topiramate (TPM) to be effective and generally well tolerated as a preventive therapy for migraine.. This paper evaluates efficacy and safety data from a pilot study of TPM 200 mg/d as preventive therapy in adult subjects with a history of migraine with or without aura.. The pilot study had a randomized, double-blind, placebo-controlled design. Subjects were randomized in a 2:1 ratio to receive TPM 200 mg/d or placebo. The double-blind treatment phase consisted of an 8-week titration period (25 mg/d for the first week, followed by weekly increases of 25 mg) and a 12-week maintenance period. The primary efficacy measure was the change in mean monthly migraine frequency. Additional measures were the median percent reduction in monthly migraine frequency and the proportion of responders (those with > or =50%, > or =75%, or 100% reduction in monthly migraine frequency).. The intent-to-treat (ITT) population included 211 subjects (138 TPM, 73 placebo; mean [SD] mean weight, 76.7 [18.7] kg). Of 45 subjects who discontinued the study in the TPM group, 21 discontinued during the titration period, compared with 3 of 13 subjects who discontinued in the placebo group. When the efficacy data were assessed using the per-protocol, analysis-of-covariance model, TPM 200 mg/d was not associated with a significant reduction in mean monthly migraine frequency compared with placebo. A post hoc analysis using a Poisson regression model in the ITT population suggested that TPM significantly reduced mean monthly migraine frequency compared with placebo (P=0.04). A significantly larger proportion of TPM-treated subjects had a > or =75% reduction in monthly migraine frequency compared with placebo (P=0.03). At least 1 adverse event was reported by 90.0% and 69.9% of the TPM and placebo groups, respectively. Treatment-emergent adverse events (AEs) occurring in > or =10% of subjects in the TPM group were paresthesia (45%), dizziness (16%), fatigue (16%), nausea (14%), and weight loss (14%). Most treatment-emergent AEs were rated mild or moderate in severity. Of 3 serious AEs (depression, abdominal pain, leg pain) occurring during the trial, none were considered related to either TPM or placebo.. In this pilot study, mean monthly migraine frequency did not differ significantly between TPM and placebo.

Topics: Adolescent; Adult; Aged; Anticonvulsants; Double-Blind Method; Female; Fructose; Humans; Male; Middle Aged; Migraine with Aura; Migraine without Aura; Pilot Projects; Poisson Distribution; Topiramate

The prophylactic treatment of migraine includes anticonvulsant drugs such as valproic acid and topiramate. However, these substances are often poorly tolerated by migraine patients. So far levetiracetam has hardly been studied as an episodic migraine prophylactic agent in adults.. To perform a prospective pilot study for the evaluation of the efficacy and tolerability of levetiracetam in the prophylactic treatment of episodic migraine.. Fifty patients with episodic migraine were enrolled in this prospective, open label study. After a baseline period of four weeks, patients received 1,000 mg (starting dose 500 mg) bid levetiracetam for 12 weeks. Migraine frequency and accompanying symptoms were recorded in a headache diary. The primary endpoint was the comparison of attack frequency during the baseline with attack frequency during the last four weeks of treatment (treatment period 3).. In the Intent-To-Treat analysis, 46% of the patients had a migraine reduction of more than 50% in the third period as compared to the baseline period. The mean number of migraine attacks decreased from 5.2 +/- 2.1 (baseline) to 3.4 +/- 2.7 (period 3). The most frequently reported side effects were somnolence, nausea, and weight gain; all were mild and transient. In a post-hoc comparison, responders to levetiracetam had significantly less migraine attacks at baseline and had significantly more often migraine with aura.. The data suggest that levetiracetam has some potential in the prophylactic treatment of episodic migraine which seems, however, to be not superior to that of other anticonvulsant drugs. Levetiracetam was well tolerated and showed better efficacy in patients with migraine with aura and in less affected migraine patients. A larger placebo-controlled, double-blind study in adults seems justified on the basis of these data.

Topics: Adult; Anticonvulsants; Double-Blind Method; Humans; Levetiracetam; Migraine Disorders; Migraine with Aura; Pilot Projects; Prospective Studies; Topiramate; Treatment Outcome; Valproic Acid

We report a 27-year-old woman, a known case of classical migraine headache, on oral contraceptive pills. She had a severe episode of migraine with visual aura attack, which continued late into the night. The next early morning, her headache persisted and she developed abrupt onset of dysarthria, right hemiparaesthesias. She attributed symptoms to her long-standing headache problem, and hence did not seek medical help for the next two weeks. The symptoms persisted despite her headache subsiding over the next 24 hours. She worsened 2 weeks later during another such episode of headache. This time, she developed right hemiparesis. The patient was admitted with provisional diagnosis of stroke. MRI of the brain showed left temporoparietal lesion and was radiologically compatible with cortical laminar necrosis.Extensive work-up was done to rule out other causes of young stroke. The patient improved with antiplatelets, antimigraine prophylaxis and stroke rehabilitation therapy.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Anticonvulsants; Aspirin; Cerebral Cortex; Cerebral Infarction; Diagnosis, Differential; Female; Flunarizine; Fructose; Humans; Magnetic Resonance Imaging; Migraine with Aura; Naproxen; Necrosis; Stroke Rehabilitation; Topiramate

Topics: Humans; Migraine Disorders; Migraine with Aura; Pyrazoles; Pyridones; Topiramate; Warfarin

Introduction Variants in the CACNA1A gene on chromosome 19p13 result in a spectrum of neurological phenotypes ranging from familial or sporadic hemiplegic migraine to congenital or progressive encephalopathies. Patients with CACNA1A variants often show acute attacks with ataxia or hemiplegia till coma, sometimes related to unilateral brain oedema. No guidelines for the medical management of these attacks are available since treatment is empiric, and many cases do not respond to common antimigraine drugs. Case description We report on the emergency personalized treatment protocol used in an 11 year-old girl with CACNA1A-related encephalopathy for the management of acute attacks of headache, hemiconvulsions and hemiplegia with coma. Discussion Combined corticosteroid pulses and hypertonic solution led to a reduction in severity and duration of acute attacks when administered in the early stages, characterized by migraine, seizure, fever, vomiting and impairment of consciousness associated to hemispheric slowing on the EEG.

Topics: Anticonvulsants; Brain Edema; Calcium Channels; Child; Dexamethasone; Drug Eruptions; Female; Fructose; Glucocorticoids; Humans; Lamotrigine; Migraine with Aura; Mutation, Missense; Topiramate; Triazines

Topiramate is an antiepileptic drug with multiple mechanisms of action that is also used for migraine prophylaxis. This study aimed to investigate the efficacy of topiramate therapy for migraine prophylaxis, based on vasomotor reactivity ([VMR] an indicator of cerebral autoregulation), and to identify changes in cerebral hemodynamics during the treatment.. We included 20 migraine (with aura) patients (group 1) and 20 healthy controls (group 2) in the study. Transcranial Doppler monitoring was performed in both groups with patients in the supine and resting position. Using a two-sided temporal window at depths of 45-60 mm for the middle cerebral artery (MCA) and depths of 60-70 mm for the posterior cerebral artery (PCA), basal flow rates and VMR values were measured. Group 1 initially received 25 mg/d of topiramate orally, and then the dose was increased 25 mg every week. At the fourth week; the optimal dose was increased to 50 mg b.i.d. and the treatment was continued at this dose. Transcranial Doppler parameters were re-evaluated 2 months after treatment. In addition, the number of attacks per month, duration of pain, and visual analog scale (VAS) scores obtained before the treatment and 2 months after the treatment in group 1 were compared.. Basal flow rates and VMR values recorded from the right and left MCA in group 1 were significantly higher than those in the control group (P < 0.05). Flow velocities obtained from the right and left MCA, and the VMR values in group 1 after topiramate treatment did not differ significantly from those in the control group (P > 0.05). In addition, the number of attacks, duration of pain, and VAS scores in group 1 were significantly lower after the treatment than before the treatment (P < 0.05).. Topiramate is an effective prophylactic treatment in migraine with aura patients and appeared to play a positive role in the regulation of cerebrovascular autonomic control.

Topics: Administration, Oral; Adult; Anticonvulsants; Blood Flow Velocity; Case-Control Studies; Cerebrovascular Circulation; Cerebrum; Female; Fructose; Humans; Male; Middle Cerebral Artery; Migraine with Aura; Posterior Cerebral Artery; Posture; Topiramate; Treatment Outcome; Ultrasonography, Doppler

A 12-year-old girl presented with headache, nausea, decreased level of consciousness, and diplopia. Brain MRI, arteriography (figure e-1 on the Neurology® Web site at www.neurology.org), vasculitic markers, and CSF were normal, as were EEGs and ECGs. Transcranial color-coded ultrasonography of the basilar artery revealed typical musical murmurs ("seagull cry") indicative of a hemodynamically significant stenosis (video).(1) Sumatriptan provided symptomatic relief; basilar flow normalized on ultrasonography (figure e-2). The clinical presentation suggested childhood migraine with aura; the ultrasound and normal arteriography suggested focal, transient vasospasm during a migraine attack. Topiramate was effective long-term. The high prevalence of childhood migraine (up to >20%)(2) suggests that ultrasound may be a useful diagnostic tool.

Topics: Anticonvulsants; Basilar Artery; Brain; Child; Echoencephalography; Female; Fructose; Humans; Migraine with Aura; Sumatriptan; Topiramate; Treatment Outcome; Vasoconstrictor Agents

Topics: Adult; Epilepsy; Female; Fructose; Humans; Migraine with Aura; Topiramate

To evaluate the chronic effect of topiramate (TPM) on cortical spreading depression (CSD), which is thought to be related to migraine aura.. Male rats (n = 30) were randomized to once-daily peroral treatment with TPM (50, 100, 200 or 600 mg/kg) or vehicle for 6 weeks. We evaluated the characteristics of CSD induced by topical application of KCl under isoflurane anesthesia and the changes in plasma level of TPM in each group. The effect of single administration of TPM on CSD was also evaluated.. After the final administration of TPM, when the plasma level of TPM was high, KCl-induced CSD frequency and CSD propagation velocity were dose-dependently reduced and the interval between CSD episodes was elongated, compared with the vehicle control. However, before the final administration of TPM, when the plasma level was very low, the KCl-induced CSD profile was the same as that in the vehicle control. Single administration of TPM did not alter the CSD profile. Local cerebral blood flow was not significantly altered by chronic administration of TPM.. TPM suppressed the frequency and propagation of CSD along the cerebral cortex, and might be a candidate for relief of migraine.

Topics: Administration, Oral; Anesthesia; Animals; Anticonvulsants; Cerebral Cortex; Cerebrovascular Circulation; Cortical Spreading Depression; Electroencephalography; Fructose; Male; Migraine with Aura; Potassium Chloride; Rats; Rats, Sprague-Dawley; Topiramate

Topics: Adult; Anticonvulsants; Comorbidity; Cyclooxygenase Inhibitors; Diclofenac; Female; Fructose; Humans; Migraine with Aura; Mydriasis; Nausea; Topiramate; Treatment Outcome; Vertigo

Forty-eight patients have been examined in the Centre of Headache Treatment. MRI of the brain revealed the changes in the white matter in 69% of patients, 39% had multiple foci (more than 3). The largest number of foci was seen in patients with frequent and chronic migraine without aura, but not in those with migraine with aura. The foci were located more often in frontal areas and less often in parietal and temporal areas. Twenty-three patients with frequent and chronic migraine received the preventive treatment with the anticonvulsant topiramate (topamax, capsules 25 and 50 mg). The duration of treatment was from 4 to 12 months depending on the disease severity. The decrease in frequency of migraine attacks was seen after 1 month of the treatment. After 6 months, mean score on the MIDAS decreased from 26.5 that indicated the severity of migraine and significant decrease in working capacity to 5.7 that corresponded to the mild form of migraine.

Topics: Adult; Anticonvulsants; Female; Fructose; Humans; Magnetic Resonance Imaging; Male; Migraine with Aura; Migraine without Aura; Neuroimaging; Severity of Illness Index; Topiramate; Treatment Outcome

Topics: Anticonvulsants; Child; Fructose; Headache; Humans; Male; Migraine with Aura; Severity of Illness Index; Topiramate

Hemiplegic migraines are characterised by attacks of migraine with aura accompanied by transient motor weakness. There are both familial and sporadic subtypes, which are now recognised as separate entities by the International Classification of Headache Disorders, edition II (ICHD-II). The sporadic subtype has been associated with other medical conditions, particularly rheumatological diseases. We report the case of a woman with sporadic hemiplegic migraine associated with CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia). Since there is a close relationship between migraine and Raynaud's phenomenon, it could be speculated that the sporadic hemiplegic migraines in our patient might be secondary to CREST syndrome.

Topics: Adult; Brain; CREST Syndrome; Diffusion Magnetic Resonance Imaging; Female; Fructose; Humans; Ischemic Attack, Transient; Magnetic Resonance Imaging; Migraine with Aura; Neuroprotective Agents; Paresis; Topiramate; Treatment Outcome

A 42-year-old patient with cognitive deficits due to childhood meningitis suffered from recurrent episodes of familial hemiplegic migraine. Additionally, he developed concomitant psychotic episodes requiring subsequent in-patient psychiatric treatment. Following combined neurological and psychiatric treatment he always recovered from the episodes within a few weeks time. Prophylactic treatment of migraine using topiramate and acetazolamide (off-label) prevented attacks for several months. When off-label compensation was refused and, as a consequence, the drug discontinued, hemiplegia relapsed within a few days. Hence, acetazolamide was prescribed again and the family paid for the medication. Since that time, the patient did not show severe attacks for at least 8 months apart from a transient attack induced by acute flu-like illness.

Topics: Acetazolamide; Adult; Anticonvulsants; Carbonic Anhydrase Inhibitors; Comorbidity; Drug Costs; Drug Therapy, Combination; Financing, Personal; Fructose; Germany; Humans; Insurance, Pharmaceutical Services; Intellectual Disability; Male; Migraine with Aura; National Health Programs; Off-Label Use; Psychotic Disorders; Topiramate; Treatment Outcome

Exploding head syndrome is a rare phenomenon but can be a significant disruption to quality of life. We describe a 39-year-old female with symptoms of a loud bang and buzz at sleep onset for 3 years. EEG monitoring confirmed these events occurred in transition from stage 1 sleep. This patient reported improvement in intensity of events with topiramate medication. Based on these results, topiramate may be an alternative method to reduce the intensity of events in exploding head syndrome.

Topics: Adult; Anticonvulsants; Auditory Perceptual Disorders; Dose-Response Relationship, Drug; Female; Fructose; Humans; Illusions; Migraine with Aura; Polysomnography; Sleep-Wake Transition Disorders; Topiramate

During the past few decades, much controversy has surrounded the pathophysiology of migraine. Cortical spreading depression (CSD) is widely accepted as the neuronal process underlying visual auras. It has been proposed that CSD can also cause the headaches, at least in migraine with aura. We describe three patients, each fulfilling the International Headache Society criteria for migraine with aura, who suffered from headaches 6-10 days per month. Two patients were treated with flunarizine and the third patient with topiramate for the duration of 4 months. All patients reported that aura symptoms resolved completely, whereas the migraine headache attacks persisted or even increased. These observations question the theory that CSD (silent or not) is a prerequisite for migraine headaches.

Topics: Adolescent; Brain; Cortical Spreading Depression; Female; Flunarizine; Fructose; Humans; Middle Aged; Migraine with Aura; Migraine without Aura; Topiramate

About 5-10% of school-age children manifest migraine headaches. Treatment options for pediatric migraine are limited. Topiramate is approved for migraine prophylaxis in adults, but its use in children is limited. We retrospectively reviewed the records of 37 patients, i.e., 22 (60%) girls and 15 (40%) boys (mean age, 14 years; range, 7.3-20.5 years), diagnosed with migraine without aura in 30 (81%), with aura in four (11%), and abdominal, ophthalmoplegic, and catamenial in one each. The mean follow-up was 12 +/- 5 months standard deviation (S.D.). Clinical response was qualified as excellent, good, no change, or worse. Numbers of headaches per month were 15 +/- 7 S.D. prior to treatment and 3 +/- 3.4 S.D. (P < 0.001) after treatment. An excellent or good response (>50% migraine reduction) was attained in 28 patients (76%). Ten (27%) patients exhibited adverse effects. Patients taking >2 mg/kg/day were more likely to demonstrate side effects. The mean dose for patients without adverse effects was 1.27 +/- 0.7 mg/kg/day S.D. Those who reported adverse effects were taking a mean dose of 2.8 +/- 1.5 mg/kg/day S.D. This study demonstrated that topiramate is an effective, safe alternative for the prophylaxis of pediatric migraine. An acceptable risk/benefit maintenance dose was < or =2 mg/kg/day.

Topics: Adolescent; Analgesics; Child; Female; Follow-Up Studies; Fructose; Humans; Male; Migraine Disorders; Migraine with Aura; Migraine without Aura; Retrospective Studies; Topiramate; Treatment Outcome; Young Adult

Topiramate has been shown to be highly effective for preventive treatment of migraine and its use has been significantly increased in the last few years. However, around 10% of migraineurs develop a worsening of their symptoms while on topiramate. We report a 33-year-old woman with familial hemiplegic migraine (FHM) who experienced worsening of her symptoms following repeated topiramate intake. Withdrawal of the drug rapidly constantly induced resolution of the symptoms. This is the first report of topiramate-associated worsening symptoms in FHM. It is important to be aware of this phenomenon, as topiramate is worldwide-used drug for migraine treatment.

Topics: Adult; Disease Progression; Fructose; Humans; Male; Migraine with Aura; Neuroprotective Agents; Topiramate

Topics: Anticonvulsants; Brain; Child; Developmental Disabilities; Dose-Response Relationship, Drug; Dystonia; Female; Fructose; Hemiplegia; Humans; Migraine with Aura; Nystagmus, Pathologic; Recovery of Function; Syndrome; Topiramate; Treatment Outcome

To evaluate the efficacy of topiramate in the treatment of migraine aura. Antiepileptic drugs may be useful in migraine prevention through such mechanisms as acting directly on the nociceptive system or by modulating the biochemical phenomena of aura. Topiramate acts directly on N-methyl-d-aspartate and amino-3-hydroxy-5-methylisoxazole-4-propionic acid/kainate glutamate receptors and modulates calcium ion channel activity by inhibiting high-voltage-activated L-type calcium ion channels.. Twelve patients with migraine with aura were enrolled in an open-label study and treated with topiramate for 6 months. The dose of topiramate was increased weekly by 25 mg up to a daily dose of 100 mg after 4 weeks.. In all 12 patients after 6 months of treatment, topiramate did not statistically influence aura frequency (P=.317) or duration (P=.480) compared with baseline. Mild to moderate side effects were observed, but they did not interfere with treatment. Consistent with previous observations, migraine frequency as well as headache intensity and duration improved statistically significantly.. Topiramate is not effective in preventing migraine aura.

Topics: Adolescent; Adult; Anticonvulsants; Female; Fructose; Humans; Longitudinal Studies; Male; Migraine with Aura; Pilot Projects; Topiramate

Topics: Central Nervous System Vascular Malformations; Conjunctival Diseases; Drug Resistance; Fructose; Headache Disorders; Humans; Male; Middle Aged; Migraine with Aura; Neuroprotective Agents; Refractory Period, Electrophysiological; Syndrome; Topiramate