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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
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
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.