Treatment of Chronic Migraine

CURRENT PAIN AND HEADACHE REPORTS

DOI: 10.1007/s11916-010-0159-x

Hans-Christoph Diener, Dagny Holle and David Dodick

Abstract

Chronic migraine is defined in different ways. The most commonly used definition is headache on more than 15 days per month in patients with migraine. Chronic migraine is difficult to treat and requires a multidisciplinary approach. Only two pharmacological treatments have been shown to be effective in placebo-controlled randomized trials: topiramate and local injection of botulinum toxin. Both therapies are effective in patients with chronic migraine with and without medication overuse. Many other substances have been investigated in chronic daily headache. All trials were underpowered and, therefore, recommendations concerning possible efficacy are not possible.

Topiramate in prevention of cluster headache in the Taiwanese

Neurology India. Year : 2010 Volume : 58 Issue : 2 Page : 284--287

WY Huang1, MC Lo2, SJ Wang3, JJ Tsai4, HM Wu5


1 Neuroscience & Psychiatry Research Lab, Changhua Christian Hospital, Changhua; and Department of Pediatrics, Kuang-Tein General Hospital, Taipei, Taiwan


2 Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan


3 Neurologial Institute, Taipei Veterans General Hospital, Taipei, Taiwan


4 Department of Neurology, National Cheng-Kung University Hospital, Tainan, Taiwan

5 Neuroscience & Psychiatry Research Lab, Changhua Christian Hospital, Changhua; Department of Neurology, Changhua Christian Hospital, Changhua; and Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan

Correspondence Address:

H M Wu

Department of Neurology, Changhua Christian Hospital, 135 Nanxiao St. Changhua City, Changhua

Taiwan

DOI: 10.4103/0028-3886.63784
Topiramate could potentially effective as prophylaxis for cluster headache, but the experience remains limited in Asians. We performed an open-label clinical study to evaluate the efficacy of topiramate in the tolerable dosage to prevent cluster headache. We studied patients who fulfilled the criteria of episodic or chronic cluster headaches (International Classification of Headache Disorders second edition) prospectively. Headache severity was assessed using a verbal rating scale (excruciating, severe, moderate, mild, and no headache). Treatment was started with a topiramate dose of 50 mg twice daily and was increased by 50-100 mg a day every 3 to 7 days as tolerated to a maximal daily dosage of 400 mg. Of the 12 patients with episodic cluster headache, nine patients had remission of headache at a mean daily dosage of 273 mg (range 100-400 mg ), and the patient with chronic cluster headache had remission at a daily dosage of 400 mg. The adverse effects included: paresthesia (84%), slow speech (54%), and dizziness (46%), but were tolerated by most patients. Two patients discontinued topiramate due to adverse events and one due to lack of efficacy.

This open-label study suggests that topiramate is effective in the treatment of cluster headache in Taiwanese patients.

Topiramate in the prevention and treatment of migraine: efficacy, safety and patient preference

Neuropsychiatric Disease and Treatment

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Authors: Steffen Naegel, Mark Obermann
Published Date December 2009 , Volume 2010:6

Steffen Naegel, Mark Obermann

Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany

Abstract: Migraine is a very common disorder characterized by the combination of typical headache with associated autonomic symptoms and/or the presence of aura. Considerable advances have been made in recent years to understand the pathophysiology of migraine, which has led to improved treatment options for the acute migraine attack as well as migraine prophylaxis. Unfortunately, preventive treatment is often insufficient to decrease migraine frequency substantially or is not well tolerated. Topiramate is an antipileptic drug with a complex mode of action which has proven its efficacy and safety in the prophylactic treatment of episodic migraine in a number of randomized controlled clinical trials. Topiramate is also effective in treating patients with chronic migraine. It has little pharmacological interaction with other drugs and is generally well tolerated by patients.