Favorable Response of Trigeminal Neuralgia to the Anticonvulsant Topiramate: A Retrospective Study
M.J. Haugh, Cephalalgia, May 2000
Objective:
To perform a retrospective analysis of patients treated with topiramate for trigeminal
neuralgia. A retrospective chart review identified eight patients aged 40-79 years (seven
female, one male) who had been treated with topiramate for 1-20 months for trigeminal neuralgia.
Conclusion:
The results in this small group of patients suggest topiramate has efficacy in the treatment
of trigeminal neuralgia. Further study is warranted in double-blind, placebo-controlled trials.
Topiramate (Topamax) for Migraine Prophylaxis: A Double-Blind, Randomized, Placebo-Controlled Study
Objective:
To determine the efficacy and safety of topiramate in migraine prophylaxis.
Background:
Antiepileptic medications are taking an increasing role in the prophylaxis of migraine
headache. Preliminary observations with topiramate, a broad-spectrum anticonvulsant, suggest
it may provide benefit in prevention of episodic migraine.
Design and Methods:
Thirty patients aged 18 to 65 years with an IHS diagnosis of migraine with or without aura
were randomized to topiramate (n=15) or placebo (n=15) after completing a 4-week baseline
phase. Patients were titrated over 6 weeks by 25-mg. increments to a maximum dose of 100 mg.
bid followed by a 12-week maintenance phase. The primary efficacy analysis was comparison of
28-day migraine frequency during the double-blind period for all patients randomized. Secondary
efficacy analysis included comparison of 28-day frequency for patients with data during
the last 10 weeks of the study, and comparison of 50% response rates in each group over
the entire double-blind period.
Results:
There was a statistical trend towards a lower 28-day migraine frequency in the topiramate group
compared to the placebo group during the entire double-blind phase (3.00 ± 2.60 vs. 3.78 ±
1.99; p=0.10).
The 50% responder rate was significantly higher in the topiramate vs. placebo group (46.7% vs. 6.7%, p=0.035). The
most common adverse events in the topiramate group were paresthesia, diarrhea, altered taste,
and somnolence. Seven patients on topiramate discontinued from the study, 4 due to adverse
events and 3 for other reasons. Six patients on placebo discontinued from the study, 3 due
to lack of efficacy and 3 for other reasons.
Conclusions:
These results suggest that topiramate has efficacy in the prophylaxis of migraine headache. Further
study is warranted in larger, placebo-controlled, multicenter trials.
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