title: Efficacy of combined topiramate/thioctic acid therapy in migraine prophylaxis.
abstract: Migraine cannot be cured and the aim, shared with the patient, is to minimise the impact of the illness on the patient's life and lifestyle. The aim of prophylaxis is to reduce the number of migraine attacks. Prophylaxis should be considered when appropriately used acute management gives inadequate control of symptoms. The efficacy and safety of topiramate 50 mg/d and thioctic acid (α-lipoic acid) 300 mg/d either as monotherapy or in combination were investigated as migraine prophylactic agents. Forty secondary school migraineur girls were enrolled in the study. The study was conducted in two phases, a prospective baseline phase and 1-month treatment phase. Combined topiramate/thioctic acid therapy was more effective than either topiramate or thioctic acid monotherapy as a migraine-preventive treatment. Combined topiramate/thioctic acid therapy decreased the mean monthly migraine frequency from 5.86 ± 1.2 to 2.6 ± 0.98 (p ⩽ 0.05), topiramate (50 mg/d) from 5.71 ± 1.4 to 4.75 ± 1.5 and thioctic acid (300 mg/d) from 5.68 ± 1.6 to 5.22 ± 1.8. Reduction in mean monthly migraine days was also significantly greater in the group receiving combined topiramate/thioctic acid (from 12.32 ± 1.85 to 5.74 ± 1.1) compared to those receiving either topiramate 50 mg/d (from 12.7 ± 1.34 to 11.85 ± 1.35) or thioctic acid 300 mg/d (from 12.5 ± 1.72 to 11.65 ± 1.44). The responder rate (% of patients showing ⩾50% reduction in monthly migraine frequency) was 85% in patients receiving combined topiramate/thioctic acid therapy compared to 30% and 20% in patients receiving either topiramate or thioctic acid, respectively. The incidence of adverse events was higher in patients receiving topiramate (50 mg/d) monotherapy. The most common adverse events were nausea, fatigue, paraesthesia and taste perversion. We conclude that combined topiramate/thioctic acid therapy is more effective and better tolerated than topiramate monotherapy. The combination has lower monthly medication costs compared to the traditionally used topiramate 100 mg monotherapy.
authors: Department of Pharmacology and Toxicology, Faculty of Pharmacy, October 6 University, October 6 City, Central Axis, Part 1/1 October 6 Governate, Egypt.
authors: Ahmed M
authors: AM
authors: Ali
authors: Thanaa G
authors: TG
authors: Awad
authors: Nagwa M
authors: NM
authors: Al-Adl
keywords: Migraine; Thioctic acid; Topiramate
references: J Chin Med Assoc. 2004 Jun;67(6):263-7
references: 15366402
references: Drugs. 2009;69(1):1-19
references: 19192933
references: Regul Toxicol Pharmacol. 2006 Dec;46(3):193-201
references: 16899332
references: Cephalalgia. 1997 Aug;17(5):580-4
references: 9251872
references: Cephalalgia. 1997 Apr;17(2):103-8
references: 9137847
references: Headache. 2007 Jan;47(1):52-7
references: 17355494
references: Biochem Pharmacol. 1991 Nov 6;42(11):2244-6
references: 1659823
references: Free Radic Biol Med. 1995 Aug;19(2):227-50
references: 7649494
references: Arch Neurol. 1979 Nov;36(11):695-9
references: 508127
references: Biochem Biophys Res Commun. 2003 Dec 5;312(1):1-6, 9-27
references: 14630011
references: Open Neurol J. 2009 Oct 01;3:64-71
references: 19888434
references: Cephalalgia. 2007 Jul;27(7):814-23
references: 17441971
references: Eur J Neurol. 2006 Jun;13(6):560-72
references: 16796580
references: Cephalalgia. 2000 Nov;20(9):765-86
references: 11167908
references: Eur J Neurol. 2009 Sep;16(9):968-81
references: 19708964
references: CNS Drugs. 2010 Jan;24(1):21-33
references: 20030417
references: Arch Neurol. 1995 Mar;52(3):281-6
references: 7872882
references: Clin J Pain. 2009 Jun;25(5):446-52
references: 19454881
references: Plast Reconstr Surg. 2009 Aug;124(2):461-468
references: 19644260
references: Arch Neurol. 2004 Apr;61(4):490-5
references: 15096395
references: Acta Neurol Belg. 2009 Sep;109(3):235-7
references: 19902820
references: Cephalalgia. 2003 Feb;23(1):39-42
references: 12534579
references: Biol Trace Elem Res. 2008 Winter;126(1-3):92-7
references: 18690416
references: Headache. 2001 Jul-Aug;41(7):646-57
references: 11554952
references: Headache. 2008 Nov-Dec;48(10):1476-81
references: 19076646
references: Headache. 2001 Feb;41(2):119-28
references: 11251695
references: Acta Neurol Scand. 1984 Jan;69(1):1-8
references: 6367336
references: Headache. 2009 Sep;49(8):1153-62
references: 19719543
references: JAMA. 2009 Jun 24;301(24):2608
references: 19549980
references: FEBS Lett. 2005 Aug 29;579(21):4892-6
references: 16109413
references: Neurology. 2002 Jun 11;58(11):1652-9
references: 12058094
references: Neurology. 2000 Sep 26;55(6):754-62
references: 10993991
references: Brain Nerve. 2009 Oct;61(10):1117-24
references: 19882937
references: Brain Nerve. 2009 Oct;61(10):1131-4
references: 19882939
references: Headache. 2009 Nov-Dec;49(10):1466-78
references: 19912346
references: Brain Nerve. 2009 Oct;61(10):1135-41
references: 19882940
references: Cephalalgia. 1994 Jun;14(3):215-8; discussion 181
references: 7954742