According to background information in the article, migraines are recurrent, disabling headaches that occur in 17 percent of women, six percent of men, and four percent of children. Approximately 53 percent of patients with severe migraines report that their attacks require bed rest or cause serious impairment. Small studies have suggested that a drug called topiramate may help in preventing migraines.
Stephen D. Silberstein, M.D., of Thomas Jefferson University Hospital, Philadelphia, and colleagues evaluated topiramate in a 26-week, randomized, double-blind, placebo-controlled study of 487 patients aged 12 to 65 years with a history of migraine.
Participants were randomized to receive placebo (n=117) or topiramate, 50 milligrams per day (n=125), 100 milligrams per day (n=128), or 200 milligrams per day (n=117).
The researchers found that the average number of migraines per month among the group taking 100 milligrams of topiramate per day decreased from about 5.4 to 3.3, and among the group taking 200 milligrams per day, the frequency decreased from about 5.6 migraines per month to 3.3. In the placebo group, migraine frequency decreased from 5.6 per month to 4.6 per month. The researchers also found that improvements occurred within the first month of treatment.
The percentage of patients who experienced a 50 percent or more reduction in migraines per month was 35.9 percent in the 50 milligram per day group, 54.0 percent in the 100 milligram per day group, 52.3 percent in the 200 milligram per day group, and 22.6 percent in the placebo group. Adverse effects included paresthesia (abnormal burning or tingling sensation), fatigue, nausea and loss of appetite.
"Topiramate, 100 or 200 milligrams per day, was effective as a preventive therapy for patients with migraine," the researchers conclude.
"Based on its efficacy herein and the tolerability profile established from its use in patients with epilepsy, topiramate should be considered a first-line treatment option for the prevention of migraine headaches," they write.
(Arch Neurol. 2004;61:490-495. Available post-embargo at archneurol.com)
Editor's Note: This study was supported by Johnson & Johnson Pharmaceutical Research & Development, LLC, Raritan, N.J.
For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org .
Journal
Archives of Neurology