Is Topiramate Effective in Preventing Pediatric Migraines?

OBJECTIVE: The objective of this selective EBM review is to determine whether or not Topiramate is effective in the prevention of pediatric migraines.Study Design: Review of three English language randomized control trials published in 2005, 2007, and 2009. DATA SOURCES: Three double-blind, placebo-controlled, randomized trials comparing various doses of Topiramate to placebo were found using PubMed, OVID, and Cochrane Library databases. OUTCOME(S) MEASURED: The frequency of migraines in patients under the age of 18 years old was documented with headache diaries. The patient’s parent would record the number, severity, duration, associated symptoms, and use of acute abortive medications. RESULTS: Three randomized, controlled studies comparing topiramate to a placebo pill were reviewed. The Lakshmi study found that topiramate was effective in preventing pediatric migraines. School absenteeism was also recorded and was found to decrease with topiramate use. The Lewis study illustrated statistically significant improvement in the number of migraines per month in the pediatric population. The Winner Study was the only RCT that revealed a reduction of migraines in the treatment group that was not statistically significant. The most common adverse effects of topiramate were weight loss, paresthesias, and anorexia. CONCLUSION: Topiramate is a safe and effective prophylactic medication for the prevention of migraines in children up to 18 years of age