Flunarizine versus topiramate for chronic migraine prophylaxis: a randomized trial.
OBJECTIVE
Chronic migraine (CM) is a prevalent and devastating disorder with limited therapeutic options. This study explored the efficacy of 10 mg/d flunarizine for CM prophylaxis as compared with 50 mg/d topiramate.


METHODS
We conducted a prospective, randomized, open-label, blinded-endpoint trial. Patients with CM were randomized to flunarizine and topiramate treatment. The primary outcomes assessed were the reductions in the total numbers of headache days and migraine days after 8 weeks of treatment. Secondary outcomes were reductions in the numbers of days of acute abortive medication intake and acute abortive medication tablets taken, and the 50% responder rate.


RESULTS
Sixty-two subjects were randomized (n=31/group). Patients treated with flunarizine showed significant reductions in the numbers of total headache days (-4.9 vs -2.3, P=.012) and migraine days (-4.3 vs -1.4, P=.001) compared with those treated with topiramate. Patients treated with flunarizine also showed significant reductions in the numbers of days of acute abortive medication intake (-2.3 vs -0.2, P=.005) and acute abortive medication tablets taken (-4.6 vs -0.5, P=.005) and had a higher 50% responder rate in terms of total headache days (58.6% vs 25.9%, P=.013) and migraine days (75.9% vs 29.6%, P=.001), compared with topiramate-treated patients. Flunarizine was generally well tolerated and had a safety profile comparable to that of topiramate.


CONCLUSIONS
Our results suggest that, in an 8-week study, 10 mg/d flunarizine is more effective than 50 mg/d topiramate for CM prophylaxis.
Department of Neurology, Taipei Municipal Gandau Hospital, Taipei, Taiwan.|Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
K-L
KL
Lai
Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
D M
DM
Niddam
Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
J-L
JL
Fuh
Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
S-P
SP
Chen
Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Y-F
YF
Wang
Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
W-T
WT
Chen
Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Gastroenterology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
J-C
JC
Wu
Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
S-J
SJ
Wang
D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005444:Flunarizine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005632:Fructose / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy* / Q000517:prevention & control; D000077236:Topiramate
D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose; D005444:Flunarizine
chronic migraine; flunarizine; prophylaxis; topiramate