Efficacy of topiramate in migraine aura prophylaxis: preliminary results of 12 patients

OBJECTIVE: To evaluate the efficacy of topiramate in the treatment of migraine aura. Antiepileptic drugs may be useful in migraine prevention through such mechanisms as acting directly on the nociceptive system or by modulating the biochemical phenomena of aura. Topiramate acts directly on N-methyl-d-aspartate and amino-3-hydroxy-5-methylisoxazole-4-propionic acid/kainate glutamate receptors and modulates calcium ion channel activity by inhibiting high-voltage-activated L-type calcium ion channels. METHODS: Twelve patients with migraine with aura were enrolled in an open-label study and treated with topiramate for 6 months. The dose of topiramate was increased weekly by 25 mg up to a daily dose of 100 mg after 4 weeks. RESULTS: In all 12 patients after 6 months of treatment, topiramate did not statistically influence aura frequency (P=.317) or duration (P=.480) compared with baseline. Mild to moderate side effects were observed, but they did not interfere with treatment. Consistent with previous observations, migraine frequency as well as headache intensity and duration improved statistically significantly. CONCLUSION: Topiramate is not effective in preventing migraine aura.