Efficacy of topiramate for the prophylaxis of drug-resistant migraine in pediatric patients

Abstract

  Objective: The purpose of this study was to elucidate the efficacy of topiramate (TPM) on drug-resistant migraine in pediatric patients. Methods: The subjects were five patients with pediatric migraine for whom preceding prophylactic medicines showed little effect. We retrospectively analyzed clinical backgrounds ; headache characteristics ; concomitant medication ; and duration, efficacy, and adverse effects of TPM administration. Results: Four patients were diagnosed with chronic daily headache at TPM initiation. The number of days with headache reduced during TPM dosage titration in all patients, and the frequency of severe headache in two. However, two patients with psychosocial problems or autism spectrum trait relapsed within 1-2 months after initiation. Although two patients had sleepiness and one had weight loss, no patient discontinued the medication because of adverse events. Conclusions: Topiramate was effective and well-tolerated in this study. Topiramate could be proposed as a prophylaxis treatment option for drug-resistant migraine in pediatric patients. However, its effects may be limited on the chronic daily headache with backgrounds of serious psychosocial/developmental problems.