- 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.
- A meta-analysis of 5 RCTs (N=531).
- Funding: None disclosed.
- 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.
- Small sample size.
- Heterogeneity across studies.
- Long-term drug efficacy should be measured.
Coauthored with Vijay Rathod, PhD