The
Upsides
Downfalls and of Topiramate
Topiramate is now among the drugs considered effective for migraine prevention— but is it safe?
TWELVE YEARS AGO, the American Headache Society( AHS) and the American Academy of Neurology( AAN) released a set of guidelines to rank the effectiveness of various medications for prevention of episodic migraine. Drugs such as amitriptyline, divalproex, propranolol and timolol made the top tier.
Topiramate, a common migraine preventive drug, had not yet been approved by the U. S. Food & Drug Administration( FDA) for prevention of episodic migraine. The medication was placed in the third tier in the 2000 AHS / AAN guidelines, as a drug that“ may” be considered for migraine prevention. 1
In the 2012 update to the AAN / AHS guidelines, topiramate graduated to the top tier of migraine preventive meds. According to a summary of the guidelines, clinical trials in the past 12 years have established the drug as effective for prevention of episodic migraine( i. e., migraines that occur six to 14 times per month). 2 One could conclude that the FDA’ s approval of topiramate for episodic migraine in 20043 as the reason for the upgrade, but this is not the case:“ Assignment of drugs to levels was based solely on grading by quality and the strength of clinical trial evidence,” says Elizabeth Loder, MD, MPH, lead author of the guidelines summary.
Topiramate’ s recent advancement in the guidelines could lead more headache specialists to prescribe the medication.
1. Silberstein.“ Practice Parameter: Evidence-based Guidelines for Migraine Headache( an Evidence-based Review).” AAN report for the Quality Substands Subcommittee of the American Academy of Neurology. 2000. 2. Loder et al.“ The 2012 AHS / AAN Guidelines for Prevention of Episodic Migraine: A Summary and Comparison with Other Recent
Clinical Practice Guidelines.” Headache. 2012; 52:930-945. 3. Warner.“ FDA Approves Topamax for Preventing Migraines.” WebMD. Aug. 12, 2004.
30 HEAD WISE | Volume 2, Issue 4 • 2012