title: Topiramate in the treatment of refractory chronic daily headache. An open trial.
abstract: Chronic daily headache (CDH) is a debilitating disorder that becomes a treatment challenge in patients refractory to the treatment. We hereby report our experience with topiramate treatment in patients with refractory CDH. The study design was a prospective, protocol-based follow-up and retrospective analysis of headache diaries. We treated with topiramate at slowly increased moderate increments 11 CDH patients who were refractory to multiple previous treatments. Topiramate treatment was effective in 7 (64%) patients. The treatment resulted in a 66% (median) decrease of the headache days per week and a significant decrease in headache severity, a reduction of the headache hours per day, and weekly analgesic consumption. These effects continued for an average follow-up of 8+/-4 months. The average effective dose was 100 mg/day. Slowly increasing the drug at moderate increments resulted in high tolerability of topiramate. We found topiramate to be an effective long-standing treatment option for patients with refractory CDH. Slow increments of the dosage contributed to high tolerability of the drug.
authors.affiliation: Department of Neurology, The Headache and Facial Pain Clinic, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Israel. mosek@tasmc.health.gov.il
authors.forename: Amnon
authors.initials: A
authors.lastname: Mosek
authors.forename: Marina
authors.initials: M
authors.lastname: Dano
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D005632:Fructose / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D020773:Headache Disorders / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010148:Intractable Pain / Q000188:drug therapy* / Q000503:physiopathology; D000077236:Topiramate; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose