The Pharmaceutical Journal
Vol 275 No 7369 p401
1 October 2005

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Topiramate licensed for migraine prophylaxis

Antiepileptic drug topiramate (Topamax) has been licensed for the prevention of migraine headaches this week.

Topiramate should be considered for adults who experience three or more migraine attacks per month or frequent migraine attacks that significantly interfere with their daily routine. It should be initiated at a dose of 25mg nightly for one week. Dosage can then be increased in increments of 25mg per day at one-weekly intervals. The maximum recommended dose is 100mg daily in two divided doses.

The summary of product characteristics for topiramate states that its initiation should be restricted to specialist care and treatment should be managed under specialist supervision or shared care arrangements.

A randomised controlled trial of topiramate versus placebo in over 550 patients showed that those receiving topiramate 100mg daily experienced 2.5 fewer migraine headaches per month. Fifty per cent of patients experienced paraesthesia; other common side effects included fatigue, upper respiratory tract infection and weight loss.

Anne MacGregor, director of clinical research at the City of London Migraine Clinic, pointed out that the British Association for the Study of Headache guidelines already recommend topiramate as second-line prophylaxis for migraine, with beta-blockers recommended as first-line prophylaxis. “I hope that [the new licence for topiramate] will make GPs feel more confident about prescribing it for migraine prophylaxis,” she added.