Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of this study was to assess the cost-effectiveness of topiramate vs. no preventive treatment in the UK. Model inputs included baseline migraine frequency, treatment discontinuation and response, preventive and acute medical cost per attack [2005 GBP ( pound)] and gain in health utility. Outcomes included monthly migraines averted, acute and preventive treatment costs and cost per quality-adjusted life year (QALY). Topiramate was associated with 1.8 fewer monthly migraines and a QALY gain of 0.0384. The incremental cost of topiramate vs. no preventive treatment was about 10 UK pounds per migraine averted and 5700 UK pounds per QALY. Results are sensitive to baseline monthly migraine frequency, triptan use rate and the gain in utility. Incorporating savings from reduced work loss (about 36 UK pounds per month) suggests that topiramate would be cost saving compared with no preventive treatment. This analysis suggests that topiramate is a cost-effective treatment for migraine prevention compared with no preventive treatment.
Cephalalgia 2006 Dec
PMID:Cost-effectiveness of migraine prevention: the case of topiramate in the UK. 1711 98

Chronic paroxysmal hemicrania (CPH) is a rare primary headache syndrome, which is classified along with cluster headache and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) as a trigeminal autonomic cephalalgia. CPH is exquisitely responsive to indomethacin so much so that the response is one of the current diagnostic criteria. The case of a patient with CPH, who had marked epigastric symptoms with indomethacin treatment and responded well to topiramate 150 mg daily, is reported. Cessation of topiramate caused return of episodes, and the response has persisted for 2 years. Topiramate may be a treatment option in CPH.
 ...
PMID:Paroxysmal hemicrania responding to topiramate. 1717 71

The usual recommended duration of preventive treatment for migraine is 3-6 months. Our aim was to explore how many patients attending a specialised clinic need prolonged preventive treatment for longer than one year. Eighty consecutive migraine patients who received preventive treatment with topiramate for 3 months with good response and tolerability were included in this observational study. All patients continued on topiramate until they had completed 6 months, when this drug was stopped. Topiramate was reintroduced if there was a worsening. Topiramate was kept for 6 more months and then discontinued again. Those patients whose headaches became worse after this second withdrawal received topiramate again and were followed-up for at least half a year. Headaches did not worsen after the first withdrawal at 6 months in 40 patients (50%), while they clearly worsened in the remaining 40 patients. At the end of the first year only two patients out of these 40 (5%) discontinued topiramate and did not notice an increase in headache frequency after two months. In conclusion, around half of the patients attending a specialised clinic due to frequent headache need preventive treatment for more than one year. Our data suggest that the current practice recommending periods of preventive treatment of 3-6 months should be reconsidered for many patients.
J Headache Pain 2007 Apr
PMID:How many migraine patients need prolonged (>1 year) preventive treatment? Experience with topiramate. 1722 43

The aim of this study was to evaluate the efficacy and tolerability of topiramate for the prevention of chronic migraine in a randomized, double-blind, placebo-controlled trial. Chronic migraine is a common form of disabling headache presenting in headache subspecialty practice. Preventive treatments are essential for chronic migraine management, although there are few or no controlled empirical trial data on their use in this patient population. Topiramate is approved for the prophylaxis of migraine headache in adults. Patients (18-65 years) who experienced chronic migraine (defined as > or =15 monthly migraine days) for > or =3 months prior to trial entry and had > or =12 migraine days during the 4-week (28-day) baseline phase were randomized to topiramate or placebo for a 16-week, double-blind trial. Topiramate was titrated (25 mg weekly) to a target dose of 100 mg/day, allowing dosing flexibility from 50 to 200 mg/day, according to patient need. Existing migraine preventive treatments, except for antiepileptic drugs, were continued throughout the trial. The primary efficacy measure was the change in number of migraine days from the 28-day baseline phase to the last 28 days of the double-blind phase in the intent-to-treat population, which consisted of all patients who received at least one dose of study medication and had one outcome assessment during the double-blind phase. Health-related quality of life was evaluated with the Migraine Specific Quality of Life Questionnaire (MSQ, Version 2.1), the Headache Impact Test (HIT-6) and the Migraine Disability Assessment (MIDAS) questionnaires, and tolerability was assessed by adverse event (AE) reports and early trial discontinuations. Eighty-two patients were screened. Thirty-two patients in the intent-to-treat population (mean age 46 years; 75% female) received topiramate (mean modal dose +/- SD = 100 +/- 17 mg/day) and 27 patients received placebo. Mean (+/-SD) baseline number of migraine days per 4 weeks was 15.5 +/- 4.6 in the topiramate group and 16.4 +/- 4.4 in the placebo group. Most patients (78%) met the definition for acute medication overuse at baseline. The mean duration of treatment was 100 and 92 days for topiramate- and placebo-treated patients, respectively. Study completion rates for topiramate- and placebo-treated patients were 75% and 52%, respectively. Topiramate significantly reduced the mean number of monthly migraine days (+/-SD) by 3.5 +/- 6.3, compared with placebo (-0.2 +/- 4.7, P < 0.05). No significant intergroup differences were found for MSQ and HIT-6. MIDAS showed improvement with the topiramate treatment group (P = 0.042 vs. placebo). Treatment emergent adverse events were reported by 75% of topiramate-treated patients (37%, placebo). The most common AEs, paraesthesia, nausea, dizziness, dyspepsia, fatigue, anorexia and disturbance in attention, were reported by 53%, 9%, 6%, 6%, 6%, 6% and 6% of topiramate-treated patients, respectively, vs. 7%, 0%, 0%, 0%, 0%, 4% and 4% of placebo-treated patients. This randomized, double-blind, placebo-controlled trial demonstrates that topiramate is effective and reasonably well tolerated when used for the preventive treatment of chronic migraine, even in the presence of medication overuse.
Cephalalgia 2007 Jul
PMID:Topiramate reduces headache days in chronic migraine: a randomized, double-blind, placebo-controlled study. 1744 71

This paper reports a clinical case of uveal effusion in both eyes causing bilateral acute angle closure glaucoma in a young patient after oral administration of topiramate, a new anticonvulsant medication. Rarely, some drugs have produced uveal effusions, forward shift of the iris-lens diaphragm, transient myopia and secondary angle closure glaucoma. A 40-year old white woman was seen at the emergency department of the "Hospital Banco de Olhos de Porto Alegre (RS)"--Brazil, with severe headaches and blurry vision in both eyes. Her medications included topiramate, started 10 days before. Slit lamp examination revealed conjunctival injection, chemosis and shallow anterior chambers. Intraocular pressure measured 40 and 38 mmHg. Fundoscopic examination findings were normal. Ultrasound scan was performed and demonstrated separation between the choroidal layer and the sclera. A diagnosis of bilateral uveal effusion associated with the use of oral topiramate was made. Topiramate was then discontinued. The patient reported symptomatic improvement by the third day after initial examination. Symptoms were resolved and visual acuity returned to normal. Topiramate may cause ciliary body edema and relaxation of zonules, which induces a forward shift of the lens-iris diaphragm with acute myopia and angle closure. As the mechanism of angle closure does not involve pupillary block, peripheral iridectomy and topical miotics are not useful in the treatment of this type of secondary angle-closure glaucoma. Drug-induced uveal effusions occur rarely. The patient improved after topiramate discontinuation.
 ...
PMID:[Bilateral acute angle closure glaucoma in a young patient receiving oral topiramate: case report]. 1750 34

Topiramate is effective in migraine headache prophylaxis. Pulmonary symptoms are rarely described as adverse effects. We report the case of a 42-year-old woman with migraine headaches who developed chronic shortness of breath while taking topiramate. Our patient experienced hand paresthesiae at a dose of 25 mg daily, and exercise induced dyspnea at doses above 50 mg daily; these symptoms worsened with increasing topiramate doses. Physical exam and chest x-ray were normal. Blood gas revealed a metabolic acidosis. Symptoms resolved after discontinuation of topiramate. Topiramate induces a lowering of blood carbon dioxide, which is usually asymptomatic. This is due to inhibition of carbonic anhydrase at the proximal renal tubule resulting in impaired proximal bicarbonate reabsorption. The decrease in CO(2) blood level facilitates the occurrence of metabolic acidosis. To our knowledge, this is the first case report of topiramate-induced dyspnea in a patient with migraine headaches.
Headache
PMID:Migraine and topiramate induced dyspnea. 1786 49

Migraine attacks are characterized as unilateral and pulsating headache with autonomic features. In about 15 % of Migraine patients the attacks are accompanied by, mostly visual, transient focal neurologic disturbances, the migraine aura. Migraine attacks of mild or moderate intensity should initially be treated with non-steroidal anti-inflammatory drugs (NSAID). A combination with prokinetic and antiemetic drugs like metoclopramide or domperidone has proved to relieve nausea and increase efficacy of the analgesic drugs. In case of severe attacks or lack of treatment efficacy the migraine attacks should be treated with 5-HT (1B/1D) receptor agonists (triptans). Patients that suffer under very frequent and/or very severe migraine attacks should receive a prophylactic treatment. Prophylactic drugs of first choice are Betablockers (Propranolol and Metoprolol), Topiramate and Flunarizine. Prophylactic treatment should be administered over a period of at least 6 - 12 months.
 ...
PMID:[Treatment of migraine]. 1792 97

Topiramate is one of several antiepileptic drugs that are used in the prevention of migraine, but the only one licensed for use in the UK. Topiramate has an extensive evidence base provided by double-blind, placebo-controlled trials to show that it is a safe, effective and well tolerated drug in the management of migraine. It has also been shown to have a role in the management of chronic migraine, which represents a challenge to primary care clinicians as well as headache specialists. Studies have demonstrated that topiramate can also be effective in preventing migraine in childhood and adolescence, although this is unlicensed in the UK. It has been shown in models both in the US and the UK to offer a cost benefit when direct and indirect costs are evaluated by reducing work loss, improving quality of life and reducing the use of increasingly scarce health resources.
 ...
PMID:Topiramate for migraine prophylaxis. 1795 1

Cluster headache is a primary headache with a male predominance that presents in two forms: episodic and chronic, occurring at 45-to 60-day intervals with one to three headaches a day lasting 45 min to 2 h. An attack starts by a violent unilateral retro-ocular pain with sympathetic signs such as tearing and rhinorrhea. Diagnosis is made by questioning and therefore requires no complementary tests. Treatment for the attack consists of injectable sumatriptan or oxygen therapy, with long-term treatment with verapamil, lithium salts, or Topiramate; in certain cases in which the number of attacks is greater than two, injections of corticosteroids at the emergence of the Arnold nerve can be used, or in cases of attacks resistant to all treatments, hypothalamus stimulation surgery can be useful.
 ...
PMID:[Cluster headache and other trigeminal-autonomic headaches]. 1804 65

This is a clinical report of a 63-year-old woman, with a 3-year history of severe episodes of hypnic headache responding to low-doses of topiramate (25 mg at bedtime). Topiramate has been used at the dosage of 100 mg/day for hypnic headache prevention in one recent case report with benefit. This report confirms the efficacy of topiramate in hypnic headache even using low-dose regimen therapy.
Headache 2008 Feb
PMID:Hypnic headache responsive to low-dose topiramate: a case report. 1808 25


<< Previous 1 2 3 4 5 6 7 Next >>