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Low-Dose Topiramate Versus Lamotrigine in
Migraine Prophylaxis (The Lotolamp Study)
Gupta P, Singh S, et al.
Posted: July 2007  
Headache 2007;47:402-412

Objective:   To assess the efficacy and safety of topiramate and lamotrigine for prophylaxis in patients with frequent migraine as compared to each other and to placebo.

Methods:   Sixty patients with frequent migraine (more than 4 attacks per month) from the headache clinic at a tertiary referral centre in India were randomized to receive 50 mg. topiramate/lamotrigine or matching placebo for 1 month each in 2 divided doses. Primary efficacy measure was responder rate (50% decrease in mean migraine frequency/intensity). Secondary efficacy measures included reduction in mean monthly frequency, intensity, duration, rescue medication use, migraine associated symptoms, and adverse events.

Results:   Fifty-seven patients comprised the intent-to-treat population. Four patients withdrew from the study at various phases, none because of the side effects. Responder rate for frequency was significantly higher for topiramate versus placebo, and versus lamotrigine. For intensity of headache also a responder rate of topiramate versus placebo and versus lamotrigine was observed. Topiramate showed statistically significant benefits in most of the secondary efficacy measures while lamotrigine was beneficial for reduction in headache frequency, and migraine associated symptoms. Adverse events were similar.

Conclusion:   Low-dose topiramate is efficacious in migraine prophylaxis as compared to both placebo and lamotrigine. Lamotrigine in low doses might be beneficial for headache frequency; however, longer trials are required to establish its efficacy on the intensity and frequency of migraine.