Topiramate is effective in pediatric migraine prevention: meta-analysis

  • Wu X & al.
  • Front Pediatr
  • 1 Jan 2020

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Topiramate significantly reduces the number of migraine days and migraine-related disability in pediatric patients compared with placebo, according to a meta-analysis of randomized controlled trials (RCTs).
  • However, there was no significant difference in the number of patients reporting a ≥50% decrease in monthly headache days.
  • Also, topiramate was associated with significantly higher rates of weight loss and paresthesia compared with placebo.

Why this matters

  • Although topiramate was approved in 2014 by the US Food and Drug Administration as the first and only drug for migraine prevention in children aged 12-17 years, studies and meta-analyses in this population have produced conflicting efficacy findings.

Study design

  • A meta-analysis of 5 RCTs (N=531).
  • Funding: None disclosed.

Key results

  • Topiramate vs placebo significantly reduced:
    • Number of migraine days (P=.0008).
    • Migraine-related disability in pediatric patients (P=.04).
  • No significant difference in the number of patients reporting a ≥50% reduction in monthly headache days between the topiramate and placebo groups (P=.11).
  • Topiramate was associated with significantly higher rates of adverse effects (all P<.01 style="list-style-type:circle;">
  • Weight loss.
  • Paresthesia.

Limitations

  • Small sample size.
  • Heterogeneity across studies.
  • Long-term drug efficacy should be measured.

Coauthored with Vijay Rathod, PhD