Cochrane for Clinicians

Putting Evidence into Practice

Topiramate for the Prophylaxis of Episodic Migraine in Adults



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Am Fam Physician. 2014 Jul 1;90(1):24.

This clinical content conforms to AAFP criteria for continuing medical education (CME). See CME Quiz Questions on page.

Author disclosure: No relevant financial affiliations.

Clinical Question

Is topiramate (Topamax) an effective prophylactic medication for adults with episodic migraine?

Evidence-Based Answer

Topiramate in a dosage of 100 mg per day is effective for decreasing the frequency of headaches in adults with episodic migraine. (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)

Practice Pointers

Migraine headaches are common, affecting approximately 18% of women and 6% of men in the United States.1 Episodic migraine describes a headache frequency of fewer than 15 days per month as opposed to chronic migraine, in which headaches occur 15 or more days per month. Pharmacologic migraine treatment options include acute and preventive therapies. Population-based studies suggest that approximately 26% of persons who have migraines need preventive therapy, but only 13% use it.1

Topiramate is an antiepileptic drug used as preventive therapy for migraines.2 This meta-analysis studied whether topiramate was effective in reducing the occurrence


The practice recommendations in this activity are available at http://summaries.cochrane.org/CD010610.

SOURCE:

Linde M, Mulleners WM, Chronicle EP, McCrory DC. Topiramate for the prophylaxis of episodic migraine in adults. Cochrane Database Syst Rev. 2013;(6):CD010610.

REFERENCES

1. Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF; AMPP Group. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68(5):343–349.

2. Silberstein SD, Holland S, Freitag F, Dodick DW, Argoff C, Ashman E. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society [published correction appears in Neurology. 2013;80(9):871]. Neurology. 2012;78(17):1337–1345.

3. Loder E, Burch R, Rizzoli P. The 2012 AHS/AAN guidelines for prevention of episodic migraine: a summary and comparison with other recent clinical practice guidelines. Headache. 2012;52(6):930–945.

These are summaries of reviews from the Cochrane Library.

The series coordinator for AFP is Corey D. Fogleman, MD, Lancaster General Hospital Family Medicine Residency, Lancaster, Pa.

A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.


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