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Clinical Conference [Preventive treatment of chronic migraine with zonisamide: a study in patients who are refractory or intolerant to topiramate] free! 2008
Pascual-Gómez J, Alañá-García M, Oterino A, Leira R, Láinez-Andrés JM. · Servicio de Neurología, Hospital Universitario de Salamanca, Salamanca, España. · Rev Neurol. · Pubmed #18985592 links to free full text
Abstract: INTRODUCTION: About half of the patients with chronic migraine do not respond or do not tolerate the different migraine preventatives. AIM: To analyse the efficacy and tolerability of zonisamide in the treatment of migraine in patients who had not responded or tolerated topiramate, the current drug of choice for the treatment of this condition. PATIENTS AND METHODS: Those patients with no response or intolerance to topiramate received zonisamide. This drug was increased 25 mg per week up to a maximum of 200 mg/day. The efficacy of this drug was evaluated in terms of 'response' (reduction in attack frequency below 50%) at the third month of treatment. RESULTS: Our series comprises a total of 34 patients, most of them middle-aged women. All met chronic migraine criteria. Zonisamide showed efficacy (response) in 19 patients (56%), response being excellent in 6 (18%). Nine patients (26%) did not show response, whereas 6 (18%) did not tolerate the drug. CONCLUSIONS: The results, obtained in patients refractory to other preventatives and particularly to topiramate, suggest that zonisamide can be useful in the prevention of chronic migraine. Of course, controlled clinical trials are necessary to confirm these preliminary results.
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Article [Determinants of prophylactic migraine therapy in Spain] free! 2007
Pascual-Gómez J, Caminero AB, Cano A, Heras-Pérez JA, Leira-Muiño R, García-Ribas G, Anonymous00026. · Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España. · Rev Neurol. · Pubmed #17979079 links to free full text
Abstract: INTRODUCTION: Migraine interferes with the quality of life of patients. Prophylactic medication is an option to be considered in cases showing inefficiency of symptomatic medication or an increase in the number of attacks. AIM: To evaluate the characteristics of patients that start on prophylactic treatment for migraine. PATIENTS AND METHODS: A multicenter epidemiologic survey was conducted in 110 neurological outpatient clinics and hospitals among adult patients of both sexes who required prophylactic treatment for migraine. Pain intensity was measured through a three-category scale: mild, moderate, or severe. Daily disability was measured by a disability questionnaire. RESULTS: A total of 735 patients with migraine who had started prophylactic treatment were considered valid for the analysis. The patients reported an average of 9.7 days with migraine in the previous month, 32% of the episodes lasting more than 24 hours. Half of the patients referred working or home disability due to migraine with a total average score of 15.1 on the disability scale (grade III). A 48% of the patients had previously received prophylactic treatment, the medications most commonly prescribed being flunarizine, propranolol and amitriptyline. At the study visit, the most commonly prescribed medications were topiramate, flunarizine, propranolol, and amitriptyline. CONCLUSIONS: Our study reveals that starting prophylactic treatment is in the majority of cases due to a high attack frequency. A clear evolution is being observed in prophylactic medication prescription, with a shift from flunarizine or propranolol to topiramate, which is prescribed more frequently nowadays.
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