Anti-epilepsy Treatments May Provide Migraine Relief

Posted: October 24, 2002

The anti-epileptic drugs Topamax and Zonegran show early promise in treating migraine headaches, researchers reported recently at the 14th Migraine Trust International Symposium in London.

Topamax (topiramate) cut the number of migraines by half in more than 50 percent of patients taking a higher study dose, according to Stephen Silberstein, M.D., FACP, director of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia.

Researchers now believe that migraines, like epilepsy, are a central nervous system disorder, which is why anti-epilepsy drugs have been tested against the headaches, Silberstein said.

In his study, patients were given 50 milligrams (mg), 100 mg or 200 mg daily of Topamax or placebo. Those taking the 100 mg and 200 mg doses had the greatest response.

The patients did experience side effects, such as nausea, depression, fatigue and nervousness. Tingling and numbness in the hands and feet were also common, but could be reduced by taking potassium supplements, said Silberstein. Side effects were slightly worse in the 200 mg dose group.

"What was amazing in this trial was the effect on weight," said Silberstein. Patients taking the higher doses of Topamax also lost an average four percent of their body weight.

Silberstein presented results of his study at the symposium in London, but had previously briefed reporters in Washington, D.C. at an American Medical Association meeting.

A drug for treating epilepsy called Zonegran (zonisamide) may help people with difficult-to-treat mixed-headache disorders, according to early results reported at the symposium.

Patients with mixed-headache disorders suffer from both migraine and tension headaches.

John Claude Krusz, Ph.D., M.D, from Anodyne Headache Pain Care in Dallas also reported the results of his study of the anti-epileptic medication Zonegran as a treatment for migraines. Krusz added Zonegran to existing preventive therapy for 50 patients attending a headache clinic.

At the beginning of the study, the patients had an average of nine migraines each month with another 16 days of tension-type headache.

The drug was begun at 100 milligrams (mg) every three or four nights for four doses, then gradually increased if necessary every other day for four to six doses up to 100 mg daily or more. Therapy was continued for three or more months at that level.

Eight patients reported better than 50 percent reduction in migraine frequency with about a 60 percent cut in tension-type headache. An additional 12 people reported between 25 and 50 percent reduction in migraine while eight individuals had no response. Four patients were lost to follow-up and another four stopped the medication due to side effects. Fourteen were still in the dosage increase phase of the study when the presentation was made.