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From the Diamond Headache Clinic in Chicago, Ill, and Midwestern University Chicago College of Osteopathic Medicine in Downers Grove, Ill (Dr Freitag); North Shore Pain Services in Valley Stream, NY (Dr Forde); Johnson & Johnson Pharmaceutical Research and Development LLC in Raritan, NJ (Drs Neto and Wang, Ms Schmitt); and Ortho-McNeil Neurologics Inc in Titusville, NJ (Drs Wu and Hulihan).

Address correspondence to Fred G. Freitag, DO, Diamond Headache Clinic, 467 W Deming Place, Chicago, IL 60614-1881. E-mail: dhcdoc{at}aol.com

Context: A substantial proportion of the patient population with migraine headache should be considered for preventive treatment based on the frequency and disability associated with this disorder. Use of the anticonvulsant topiramate was previously examined in two large, double-blind, randomized, placebo-controlled clinical trials of a subset of patients who have 3 to 12 migraine episodes per month.

Objective: To better characterize the efficacy of topiramate for prevention of migraine, with or without aura, by pooling and analyzing data from the two large clinical trials.

Methods: The pooled intent-to-treat population included 937 patients receiving topiramate at one of three dosages (50 mg/d, 100 mg/d, 200 mg/d) or placebo. Outcome measures included change in mean monthly migraine frequency and categorical responder rate throughout the 26-week doubleblind phase.

Results: At daily doses of 100 and 200 mg, topiramate was associated with significant reductions in mean monthly migraine frequency throughout the double-blind phase compared with placebo (P<.001). Significantly more patients treated with these topiramate doses exhibited high-percentage reductions in monthly migraine frequency (50% [P<.001], 75% [P<.001], 100% [P=.049]) versus placebo. The most common adverse events included anorexia, cognitive deficits, diarrhea, fatigue, nausea, and paresthesia. Topiramate (100 mg/d, 200 mg/d) was associated with significant and sustained reductions in mean monthly migraine frequency beginning as early as 1 week into therapy.

Conclusion: Pooled efficacy data from two large, similarly designed, placebo-controlled migraine-prevention trials demonstrated that a statistically significant proportion of patients using topiramate met or exceeded two main outcome guidelines recommended by the International Headache Society (50% and 75% reduction in frequency of monthly attacks). Based on efficacy and tolerability, topiramate at a dosage of 100 mg per day (50 mg twice daily) should be the target dosage for most patients with migraine.