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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Topiramate for migraine prevention

Toparimate (Topamax®) is growing in popularity for the prevention of migraine. This is a licensed indication but current Clinical Knowledge Summary (CKS) recommendations suggest that this drug should only be initiated by specialists.

A recent assessment conducted by the National Prescribing Service in Australia has supported this second line position and also provides some useful information regarding efficacy and side effects.

The NPS assessment concludes:

  • Topiramate is an alternative migraine-prevention option for adults unable to take beta blockers or pizotifen
  • Around 50% of patients using topiramate experienced paraesthesia
  • Cognitive effects (cognitive slowing, language difficulties and difficulties with memory and concentration) are common (6% to 7%) and lead to treatment withdrawal in up to 3% of patients
  • There is no evidence that topiramate is more effective than other migraine-prevention drugs

Action: Based upon these conclusions and the information provided in the CKS on Migraine, topiramate should be restricted to use in patients where beta-blockers and amitriptyline have proven to be ineffective or are not tolerated.

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