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Topiramate Approved for Migraine Prevention in Adolescents

April 14, 2014

Topiramate Approved for Migraine Prevention in Adolescents

  1. Amy Orciari Herman, Physician's First Watch

Now we have an effective medication for prophylaxis.

  1. Amy Orciari Herman, Physician's First Watch

The FDA has approved the antiepileptic topiramate (Topamax) to prevent migraine in adolescents aged 12 to 17 years. It's the first drug approved for migraine prevention in this age group.

Topiramate should be taken daily, at a dose of 100 mg. Its approval was based on a randomized trial of roughly 100 adolescents: Those taking topiramate experienced a 72% decrease in migraine frequency, versus 44% among placebo recipients. Side effects included paresthesia, upper respiratory infection, loss of appetite, and abdominal pain.

Like all antiepileptic drugs, topiramate may increase the risk for suicidality. In addition, its use during pregnancy places infants at risk for oral clefts. Topiramate has been approved to prevent seizures since 1996 and to prevent migraine in adults since 2004.

Comment

  1. Alain Joffe, MD, MPH, FAAP

Migraine headache management can be a challenging issue for families and pediatricians, in part because diagnosis can be difficult (JW Pediatr Adolesc Med Jan 30 2013). In a recent study, cognitive behavioral therapy plus amitriptyline was more effective than headache education alone for treating chronic migraines (JW Pediatr Adolesc Med Jan 14 2014). Now we have an effective medication for prophylaxis. One note of caution however: Not only can topiramate use place infants at risk for oral clefts if their mothers use it during pregnancy, but it can also interfere with the effectiveness of oral contraceptives. Hence, to prevent unintended pregnancy, it is critical to obtain a careful medication history before starting therapy and make adjustments as needed.

  • Disclosures for Alain Joffe, MD, MPH, FAAP at time of publication Editorial boards Adolescent Medicine: State of the Art Reviews; JAMA Pediatrics

Citation(s):

Reader Comments (1)

Dr. V Kantariya MD Physician, Family Medicine/General Practice

The American Heart Association/American Stroke Association has issued the first guideltnes for reducing stroke in women. Migraine with aura increase stroke risk in women across the lifespan.Topamax approved for migraine prevention.We want to reduce Stoke risk.How about it?

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