Topamax now available as a preventative treatment for migraine attacks

Although migraine is a common, distressing condition, many people remain undiagnosed or inadequately treated. It is estimated that 6% of males and 18% of females worldwide suffer from migraine and overall it affects approximately 11% or almost 2 million Australians. Although it is recommended that acute attacks of migraine should be treated with simple over-the-counter analgesics, research has found that many patients use these drugs inappropriately. It has also been found that less than one quarter of suitable patients are using the recommended preventative drugs for migraine such as Topamax (topiramate), propranalol, amitriptyline, valproate and timolol.

What is Migraine?

Migraine is a common disorder with various presentations. Migraines cause symptoms such as severe headaches (often located on one side of the head and throbbing in character), nausea, vomiting and increased sensitivity to bright lights (photophobia) and loud noises (phonophobia). Some patients may also experience an aura, such as abnormal lines in the visual field, prior to the development of their migraine.

The underlying cause of migraines is not entirely understood but abnormalities in the vessels surrounding the brain are thought to be contributing factors. In some cases migraine can run in families.

Treatment of Migraine

If you suffer from migraines, you will understand that they can be very distressing. Sometimes the headaches can disable you for several days at a time and interfere with your work, family commitments and general quality of life. For this reason it is recommended that migraine sufferers receive appropriate treatment. In particular, patients who experience 2 or more migraines that last 3 or more days per month should consider prophylactic (preventative) drugs to reduce the frequency and severity of attacks.

Preventative drugs can half the frequency of your migraine attacks. Thus following an acute migraine attack, it is your doctor’s role to discuss with you the various preventative options available.

Research has shown a number of agents including propranolol (Inderal), timolol, amitriptyline (Endep), sodium valproate (Epilim), and topiramate (Topamax) are effective and safe first-line agents for migraine prevention. Research has also shown that only about one quarter of patients suitable for preventative drugs actually receive appropriate therapy. General practitioners (GPs) often prescribe only a select group of the available drugs, perhaps because they are unfamiliar with all the newer drugs available and partly because many of the proven agents are not yet registered for their use in migraine prevention.

Furthermore, studies have shown that patients often use agents for acute attacks (such as analgesics, triptans and ergotamines) inappropriately as preventative drugs. This can cause a paradoxical rebound increase in headaches and convert some episodic cases to chronic migraines.

The promising results in research of several migraine prevention drugs, and the current under-treatment of migraine sufferers, has therefore called for measures to increase the availability of migraine prophylactic agents. One positive step has been the addition of a drug called Topamax (topiramate) to the Australian Pharmaceutical Benefits Scheme (PBS) from December 1st, 2007.

What is Topamax?

Topamax is a versatile drug that has been used for several years in the treatment of various forms of epilepsy (a recurrent seizure disorder). More recently studies have found that Topamax can also reduce the occurrence of migraines, and has been used for this purpose since 2004. Only this year, however, has Topamax been added to the PBS, which means patients now have access to the drug at a subsidised price. This means greater availability of the drug, increased awareness and less out-of-pocket expenses for patients. Hopefully this will lead to better treatment and prevention of migraines in the future.

You may be eligible for this drug if you meet the following criteria:

• You get frequent migraines that disrupt your life.
• You are overusing or cannot use acute medications.
• You cannot take other medications such as beta blockers or pizotifen. For example, beta-blockers may be contraindicated if you suffer from asthma.

You should discuss with your doctor whether this medication is suited to you and whether you fit the criteria to qualify for an authority script.

Please refer to our article on Topamax for further information, including dosing and side effects.

Of course, drugs are not the only approach to migraine. Think about your lifestyle. Triggers that may bring on attacks include chocolate, caffeine, medications, periods, weather changes, late nights and physical or emotional stress. Conversely, you may benefit from relaxation, meditation, walking or other exercise. Keeping a diary of your migraine attacks, associated symptoms, triggers and effects of medications may also help you and your doctor establish which treatments are best for you.