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Predictors of a Negative Response
to Topiramate Therapy in Patients with Chronic Migraine
Rothrock JF, Parada VA, et al.
Posted: January 2006  
Headache 2005;45:932-935

Objective:  To identify variables predictive of a negative response to prophylactic therapy with topiramate in patients with chronic migraine.

Background:   While certain of the newer antiepileptic drugs (AEDs) have emerged as promising or definitely effective therapies for migraine prevention, we continue to lack biologic or clinical variables predictive of treatment response to these or other widely used prophylactic therapies.

Methods:  A consecutive series of 170 patients with IHS-defined migraine who were experiencing 15 or more days of headache per month were treated with topiramate according to a uniform dosing protocol.

Results:   A total of 116 patients completed at least 60 days of treatment and consequently were available for analysis. In the efficacy analysis, 45 of the 116 responded positively to topiramate. Those patients with chronic daily headache of more than 6 months duration, patients who previously had tried and failed more than 3 prophylactic agents and patients who previously had failed to respond to divalproex sodium were more likely to be nonresponders, but after multiple regression analysis the only statistically significant predictor of a negative treatment response was chronic daily headache of more than 6 months duration.

Conclusions:  Patients with chronic migraine who are treated with topiramate may respond positively at a rate approaching that reported from placebo-controlled trials involving topiramate or other AEDs administered to less severely afflicted migraineurs. Our analysis suggests that patients with chronic migraine least likely to respond to topiramate would be those with extensive and negative previous experience with prophylactic therapy, previous failure to respond to divalproex sodium, chronic daily headache, and, most notably, chronic daily headache of more than 6 months duration.