Magazine article Clinical Psychiatry News

Topiramate May Cut Basilar Migraine Frequency

Magazine article Clinical Psychiatry News

Topiramate May Cut Basilar Migraine Frequency

Article excerpt

CHICAGO -- Topiramate reduced the frequency of basilar migraine by up to 75% in almost 90% of children who took the drug for migraine prevention, Dr. Donald Lewis reported in a poster presentation at the annual meeting of the American Headache Society.

Migraine drugs are considered successful if they produce at least a 50% improvement in at least 50% of patients, said Dr. Lewis, a pediatric neurologist at Children's Hospital of the King's Daughters, Norfolk, Va.

Using this standard, 86% of the patients in Dr. Lewis' study responded to the medication.

Although the study was small--just 14 children--the robust results are a significant finding, he said in an interview.

"We had a much-better-than-usual clinical response for migraine preventatives. This study cries out to be replicated in a large multicenter trial," he said.

Topiramate (Topamax), manufactured by Ortho-McNeil, previously has been approved as an adjunctive therapy for seizures. However, the drug is not approved for any headache indication in children, but is used off label, Dr. Lewis said.

The study randomized 14 children with basilar migraine to 25 mg or 100 mg/day of topiramate. Their mean age was 13 years; age of onset of basilar migraine ranged from age 2 to 13 years.

At baseline, they had from 4 to 12 migraine days per month, with most reporting severe or excruciating pain (only two reported moderate pain). The mean duration of migraine was 5 hours (range 1-10 hours).

After a 4-week washout period, the children took topiramate for 12 weeks. Both groups experienced a significant decrease in mean monthly migraine days: 3 days (64%) for the 25-mg group and 3.6 days (75%) for the 100-mg group.

Patients in the 25-mg group experienced a 75% reduction in the mean monthly rate of basilar type migraine, while those in the 100-mg group experienced an 82% reduction. …

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