By Thomas S. May
STOCKHOLM, SWEDEN -- June 29, 2007 -- The anticonvulsant drug topiramate is more effective than flunarizine, a calcium channel blocker, for chronic migraine prophylaxis, suggest study results presented here at the 13th Congress of the International Headache Society (IHS).
The research was a head-to-head comparison of the two agents, both of which had proved efficacious in the prevention of migraine attacks in previous studies.
"New criteria [according to the International Classification of Headache Disorders, 2nd edition (ICHD-2)] for chronic migraine are very restrictive, as they only allow patients that treat and relieve their attacks with triptans to be included," said lead author, Manuel Gracia Naya, MD, neurologist, Hospital San Jorge, Huesca, Spain.
Because of the new ICHD-2 criteria, only 62 patients (36 on topiramate and 26 on flunarizine) out of nearly 400 migraineurs using one of these two drugs for migraine prophylaxis were included in the statistical analysis, Dr. Gracia Naya explained. In Spain, approximately 50% of patients treat their migraine attacks with nonsteroidal anti-inflammatory drugs (NSAIDs), and about 15% to 20% use triptans, he added.
When the researchers compared the number of days with migraine headache in the month prior to treatment and after 4 months of treatment, they found that there was a significant decrease (P =.0001) in the mean number of severe attacks in both groups. Patients treated with flunarizine showed a 41.1% decrease in the number of days with headache, while those receiving topiramate had a 61.9% reduction (P =.0081 for difference between groups).
The researchers found no significant difference between the two groups in terms of adverse effects or drop-out rates.
These results indicate that both topiramate and flunarizine are effective when used as prophylactic treatment of chronic migraine, according to Dr. Gracia Naya. However, he noted, the combination of topiramate with a triptan is more effective than the combination of flunarizine and a triptan at reducing the number of attacks.
The findings also suggest that topiramate could be considered as a first-line treatment for chronic migraine prophylaxis, the researchers concluded.
[Presentation title: Effectiveness of Topiramate and Flunarizine for Chronic Migraine: a Comparative Case-Series Study. Abstract F033]
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