Topiramate may help prevent migraine in teens

NEW YORK (Reuters Health) - Research hints that adolescents with migraine may suffer fewer headaches when treated with the drug topiramate, which is usually used as an anti-seizure treatment.

"The general goals of preventative treatment are to reduce the frequency, severity and duration of attacks, improve responsiveness to treatment of acute attacks, and improve function, reduce disability and improve quality of life," Dr. Wendy P. Battisti and associates write in the journal Headache.

Nevertheless, no preventive treatment regimens have been approved for children with chronic migraine, although there are data to suggest that topiramate could be effective in children.

To further appraise the drug's potential, Battisti, from Johnson & Johnson Pharmaceutical Research and Development in Raritan, New Jersey, and her team pooled data from three clinical trials that included patients aged 12 to 17 years old who had roughly 3 to 12 migraines per month.

Randomization resulted in 12 adolescents assigned to placebo, 11 to topiramate 50 mg/day, 13 to 100 mg/day, and 13 to 200 mg/day.

Those taking 100 mg/day saw a 63 percent median drop off in the frequency of monthly migraine attacks and those taking 200 milligrams daily saw a 65 percent reduction in monthly migraine attacks.

The placebo group, on the other hand, saw only a 13 percent reduction in migraine frequency. The results for the 50 mg/day topiramate dose did not differ from placebo.

Overall, the adolescents tolerated topiramate well, with no serious drug-related adverse events. But because adverse events were more frequent at the 200-mg/day dose, "lower doses may provide a superior benefit to risk profile for adolescents."

Battisti and colleagues admit that firm conclusions cannot be drawn from their analysis, but based on current evidence, they report that a larger, randomized controlled trial to assess the potential of topiramate to prevent migraine attacks in children has been initiated.

SOURCE: Headache, November/December 2006.