title: Topiramate in the prophylactic treatment of cluster headache.
abstract: OBJECTIVE
  The role of topiramate in the prophylactic treatment of cluster headache is still unclear. The aim of this study was to evaluate the effectiveness of topiramate in a group of patients with refractory episodic or chronic cluster headache.
  
  
  BACKGROUND
  Proof of efficacy of preventive treatment of cluster headache is limited, especially for the chronic form of the disorder. There are very few randomized clinical trials on this condition with topiramate or other new anticonvulsant agents. Recent case reports and series involving topiramate have shown good results. The mechanism of action of topiramate is unknown, but is presumably mediated by gamma-aminobutyric acid.
  
  
  METHODS
  Twenty-six patients with episodic (n = 12) or chronic (n = 14) cluster headache were studied prospectively. All patients had been treated with some preventive treatment, with poor or no response. Treatment with topiramate was initiated with 25 mg once a day, and the dose was titrated every 3 to 7 days to a maximum of 200 mg, according to clinical response and tolerability.
  
  
  RESULTS
  Topiramate rapidly induced cluster remission in 15 patients, reduced the number of attacks more than 50% in 6 patients, and reduced the cluster period duration in 12. The mean time to remission was 14 days (range, 1 to 27), but in 7 patients remission was obtained within the first days of treatment with very low doses (25 to 75 mg a day). Tolerability was good within the lower range of doses used. Six patients discontinued treatment due to side effects (all with daily doses over 100 mg) or lack of efficacy.
  
  
  CONCLUSIONS
  Our results confirm that topiramate can be an effective option for the preventive treatment of episodic and chronic cluster headache.
authors.affiliation: Department of Neurology, Hospital Clínico Universitario, Universidad de Valencia, Avenida Blasco Ibañez 17, 46-010 Valencia, Spain.
authors.forename: Miguel J A
authors.initials: MJ
authors.lastname: Láinez
authors.forename: Julio
authors.initials: J
authors.lastname: Pascual
authors.forename: Ana M
authors.initials: AM
authors.lastname: Pascual
authors.forename: Jose M
authors.initials: JM
authors.lastname: Santonja
authors.forename: Alejandro
authors.initials: A
authors.lastname: Ponz
authors.forename: Antonio
authors.initials: A
authors.lastname: Salvador
mesh_terms: D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D002908:Chronic Disease; D003027:Cluster Headache / Q000517:prevention & control*; D005260:Female; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D000077236:Topiramate; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose