Stopping Migraine Before It Starts

The FDA has approved the daily use of the anticonvulsant drug canadian topiramate (Topamax®, Ortho-McNeil) to prevent migraine headaches.

Stopping migraines before they start is controversial. The therapy may reduce the frequency of migraines but rarely eliminates them entirely.

In two studies of 900 patients who suffered four to eight migraines a month, the patients were given daily doses of the drug or a placebo. About 50% of the patients taking Topamax® reported at least a 50% reduction in the number of monthly headaches. Most patients who responded to therapy started feeling better in the first month.

Beta blockers, tricyclic antidepressants (TCAs), calcium-channel blockers, and even botulinum (Botox®) are also prescribed to prevent migraine; however, beta blockers can make exercise difficult, TCAs are associated with potential urination problems and weight gain, calcium-channel blockers may work better than beta blockers for migraine accompanied by an aura, anticonvulsants (e.g., Topa-max®) may cause tingling and memory lapses, and Botox® is expensive.

The most common side effects of Generic Topamax are tingling and fatigue and occasional memory or concentration problems. From 5% to 12% of patients reported weight loss.

Most patients use triptans (e.g., suma-triptan succinate [Generic Imitrex®]) to relieve occasional migraines, but these do not work for 20% to 30% of patients.

Doctors hope that the attention given to the recent drug approval will prompt more patients to seek treatment for their pain. The problem is often undertreated, either because patients don’t ask for help or because doctors don’t take it seriously.

Whereas a six-month supply of Topa-max costs $655, a six-month supply of generic propranolol sells for $16.