topiramate and Migraine-without-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

The aim of this study was to compare the recovery cycle of somatosensory evoked potentials (SEPs) in children with migraine without aura before and after treatment with topiramate. Eleven migraine children were studied before and after a 3-month treatment with topiramate at the average dose of 1.3 mg/kg/day. We calculated the SEP latency and amplitude modifications after paired electrical stimuli at 5, 20 and 40 ms interstimulus intervals, comparing them with a single stimulus condition assumed as baseline. In nine patients, who had a significant reduction in headache frequency after treatment, the recovery cycles of the P24 (P = 0.03) and N30 (P < 0.005) potentials were longer after than before topiramate treatment. In two migraineurs who did not show any improvement, the recovery cycles of the cortical SEP components were even shorter after treatment. Our results suggest that topiramate efficacy in paediatric migraine prophylaxis is probably related to restored cortical excitability.

Topics: Adolescent; Anticonvulsants; Child; Electric Stimulation; Evoked Potentials, Somatosensory; Female; Fructose; Humans; Male; Migraine without Aura; Reaction Time; Somatosensory Cortex; Topiramate

Migraine is characterized by reduced habituation of multimodal evoked potentials, which in turn reflects an abnormal pattern of cortical excitability. We assessed the effects of a 2-month treatment with topiramate or levetiracetam vs placebo on contingent negative variation (CNV) habituation and amplitude in a cohort of migraine without aura (MO) patients. Forty-five MO patients were selected from a university-based outpatient clinic and randomly assigned to 100mg topiramate or 1000mg levetiracetam or placebo in a double-blind design. Twenty-four control subjects were also recruited. The initial CNV (iCNV) amplitude and habituation were assessed by Cz/A1-A2 derivation recordings in the basal condition (T0) and after 2 months of treatment (T1). Both topiramate and levetiracetam produced a significant reduction in migraine frequency compared to placebo, they also reversed the abnormal iCNV habituation pattern which characterized the MO patients in the basal condition and which was not present in controls. For migraine patients, the reduced migraine frequency and habituation index following treatment were significantly correlated. A lack of habituation of evoked responses is an interictal endophenotypic marker in migraine, the reversion of which may improve disease outcome. These results suggest a role for neurophysiological methods in the management of migraine.

Topics: Acoustic Stimulation; Adolescent; Adult; Analysis of Variance; Anticonvulsants; Contingent Negative Variation; Double-Blind Method; Electroencephalography; Female; Fructose; Habituation, Psychophysiologic; Humans; Levetiracetam; Male; Middle Aged; Migraine without Aura; Piracetam; Time Factors; Topiramate

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

To monitor weight regain after therapy discontinuation in patients with migraine experiencing weight loss during topiramate (TPM) treatment.. Patients with migraine without aura were enrolled in this observational prospective study. Weight, body mass index (BMI), waist circumference, systolic and diastolic blood pressure, plasma levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, leptin, and ghrelin, and homeostatic model assessment of insulin resistance (HOMA-IR) were evaluated before starting TPM (T1), at 3 (T2) and 6 (T3) months of treatment and 6 months after withdrawal of TPM (T4). Weight loss/regain was considered as a change of 5% of pre-TPM body weight.. A total of 241 patients were analyzed. Of these, 87 (36%) patients experienced weight loss on TPM medication. During TPM therapy significant reductions in mean values of weight (p<0.001), BMI (p<0.001), waist circumference (p<0.01), HOMA-IR (p<0.01), and leptin (p<0.01) were observed. After TPM discontinuation, all of these parameters showed a clear trend to increase at T4, achieving pre-TPM values in 27 patients. Among potential predictors, only HOMA-IR before starting TPM (parameter estimate=1.36, effect size=0.75; p=0.006) was significantly associated with weight regain after therapy discontinuation.. Loss of body weight is a reversible effect, which at 6 months after TPM discontinuation shows a clear trend to return to baseline values. HOMA-IR is the only predictive factor of weight regain.

Topics: Adult; Body Mass Index; Central Nervous System Agents; Cholesterol; Female; Fructose; Humans; Insulin Resistance; Linear Models; Male; Migraine without Aura; Prognosis; Prospective Studies; Severity of Illness Index; Topiramate; Waist Circumference; Weight Gain; Weight Loss; Young Adult

Topics: Causality; Disease Progression; Female; Fructose; Headache Disorders; Headache Disorders, Primary; Humans; Hyperacusis; Middle Aged; Migraine without Aura; Models, Neurological; Nausea; Nociceptors; Photophobia; Topiramate; Trigger Points

Various visual and sensory phenomena have been described in migraine with aura. Among those, the 'Alice in Wonderland' syndrome is defined as a distortion of the body image with the patient being aware of its unreal nature. Here, the case of a 17-year-old girl with migraine without aura who developed an 'Alice in Wonderland' syndrome repeatedly on topiramate treatment was presented and potential pathophysiological concepts were discussed.

Topics: Adolescent; Anticonvulsants; Body Image; Female; Fructose; Hallucinations; Humans; Migraine without Aura; Topiramate

Topics: Adult; Anticonvulsants; Female; Fructose; Humans; Magnetic Resonance Imaging; Malpractice; Migraine without Aura; Patient Rights; Physician-Patient Relations; Topiramate; Treatment Outcome

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

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

The current case describes epistaxis in a patient treated with a daily regimen of topiramate 100mg for migraine. The patient had not a past medical history of nosebleeds and laboratory parameters were within normal ranges. She was then advised to withdraw topiramate, and the epistaxis resolved within 12 hours after its discontinuation. Since then, the patient never complained other blood clotting disorders. The potential antiplatelet activity of topiramate is discussed.

Topics: Adult; Blood Platelets; Epistaxis; Female; Fructose; Humans; Migraine without Aura; Neuroprotective Agents; 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