title: [Does medication abuse in patients with chronic migraine influence the effectiveness of preventive treatment with topiramate?].
abstract: BACKGROUND
  Patients with chronic migraine (CM) and medication abuse are difficult to treat, and have a greater tendency towards chronification and a poorer quality of life than those with other types of headache.
  
  
  OBJECTIVE
  To evaluate whether the presence of medication abuse lowers the effectiveness of topiramate.
  
  
  METHODS
  A series of patients with CM were grouped according to whether they met abuse criteria or not. They were advised to stop taking the drug that they were abusing. Treatment was adjusted to match their crises and preventive treatment with topiramate was established from the beginning. The number of days with headache and intense migraine in the previous month and at four months of treatment was evaluated.
  
  
  RESULTS
  In all, 262 patients with CM criteria were selected and 167 (63.7%) of them fulfilled abuse criteria. In both groups there was a significant reduction in the number of days with headache/month and number of migraine attacks/month at the fourth month of treatment with topiramate. The percentage of reduction in the number of days with headache/month in CM without abuse was 59.3 ± 36.1%, and with abuse, 48.7 ± 41.7% (p = 0.0574). The percentage of reduction in the number of days with intense migraine/month in CM without abuse was 61.2%, and with abuse, 50% (p = 0.0224). Response rate according to the number of days with headache/month in CM without abuse was 69%, and with abuse, 57%. Response rate according to the number of intense migraines/month in CM without abuse was 76.8%, and in CM with abuse, 61% (p = 0.0097).
  
  
  CONCLUSIONS
  Topiramate was effective in patients with CM with and without medication abuse, although effectiveness is lower in the latter case.
authors.affiliation: HUMS. Hospital Universitario Miguel Servet, 50009 Zaragoza, Espana.
authors.forename: M
authors.initials: M
authors.lastname: Gracia-Naya
authors.forename: N
authors.initials: N
authors.lastname: Hernando-Quintana
authors.forename: A M
authors.initials: AM
authors.lastname: Latorre-Jimenez
authors.forename: C
authors.initials: C
authors.lastname: Rios
authors.forename: J
authors.initials: J
authors.lastname: Artal-Roy
authors.forename: M J
authors.initials: MJ
authors.lastname: Garcia-Gomara
authors.forename: S
authors.initials: S
authors.lastname: Santos-Lasaosa
authors.forename: S
authors.initials: S
authors.lastname: Sanchez-Valiente
authors.forename: J A
authors.initials: JA
authors.lastname: Mauri-Llerda
mesh_terms: D000328:Adult; D000700:Analgesics / Q000009:adverse effects* / Q000493:pharmacokinetics; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000493:pharmacokinetics; D004347:Drug Interactions; D062787:Drug Overdose / Q000150:complications*; D005260:Female; D005632:Fructose / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D020773:Headache Disorders / Q000188:drug therapy / Q000517:prevention & control; D051271:Headache Disorders, Secondary / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control*; D017060:Patient Satisfaction; D019966:Substance-Related Disorders / Q000150:complications*; D000077236:Topiramate; D016896:Treatment Outcome; D014363:Tryptamines / Q000009:adverse effects* / Q000493:pharmacokinetics; D055815:Young Adult
chemical_list: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D014363:Tryptamines; D000077236:Topiramate; D005632:Fructose