Topiramate in the prevention of migraine: a review of its efficacy, tolerability, and acceptability

Domenico D’Amico, Licia Grazzi, Gennaro Bussone

Headaches and Cerebrovascular Disorders Unit, C. Besta National Neurological Institute, Milan, Italy

Abstract: This paper reviews the results of placebo-controlled trials on topiramate (TPM) in the prophylaxis of migraine, focusing particularly on efficacy and tolerability of the target dose (100 mg/day). Data from well-conducted trials and analyses of pooled data show that TPM is effective against migraine, confirming the experience of physicians in various countries. High responder rate and good tolerability following slow titration suggest TPM as a first-line option for migraine prophylaxis. Patient acceptability may be enhanced by lack of weight gain, lack of major contraindications, and positive effects on quality of life.

Keywords: migraine, topiramate, prophylaxis, clinical trials, tolerability, acceptability