The effects of topiramate therapy on cerebral metabolism in migraine with aura patients

Abstract

AIm:Topiramate is an antiepileptic drug with multiple mechanisms of action that is also used for migraine prophylaxis. This study aimed to investigate the efficacy of topiramate therapy for migraine prophylaxis, based on vasomotor reactivity ([VMR] an indicator of cerebral autoregulation), and to identify changes in cerebral hemodynamics during the treatment. mATERIAL and mETHods:We included 20 migraine (with aura) patients (group 1) and 20 healthy controls (group 2) in the study. Transcranial Doppler monitoring was performed in both groups with patients in the supine and resting position. Using a two-sided temporal window at depths of 45-60 mm for the middle cerebral artery (MCA) and depths of 60-70 mm for the posterior cerebral artery (PCA), basal flow rates and VMR values were measured. Group 1 initially received 25 mg/d of topiramate orally, and then the dose was increased 25 mg every week. At the fourth week; the optimal dose was increased to 50 mg b.i.d. and the treatment was continued at this dose. Transcranial Doppler parameters were re-evaluated 2 months after treatment. In addition, the number of attacks per month, duration of pain, and visual analog scale (VAS) scores obtained before the treatment and 2 months after the treatment in group 1 were compared.REsuLTs: Basal flow rates and VMR values recorded from the right and left MCA in group 1 were significantly higher than those in the control group (P < 0.05). Flow velocities obtained from the right and left MCA, and the VMR values in group 1 after topiramate treatment did not differ significantly from those in the control group (P > 0.05). In addition, the number of attacks, duration of pain, and VAS scores in group 1 were significantly lower after the treatment than before the treatment (P < 0.05). CoNCLusIoN:Topiramate is an effective prophylactic treatment in migraine with aura patients and appeared to play a positive role in the regulation of cerebrovascular autonomic control. BuLGuLAR: Topiramat tedavisi öncesi migren grubunda OSA bazal akım hızları ile VMR değerleri istatistiksel olarak anlamlı derecede (p<0,05) yüksek bulundu. Migren grubunda topiramat tedavi sonrası saptanan, sağ ve sol OSA'dan elde edilen bazal akım hızları ile VMR değerleri, kontrol grubu ile karşılaştırıldığında farklılık saptanmadı (p>0,05).soNuÇ: Migrenli hastaların proflaktik tedavisinde, topiramatın iyi bir seçenek olduğu ve serebrovasküler otonomik kontrolün regülasyonunda rol oynadığı söylenebilir.

Adjuvant Migraine Medications in the Treatment of Sudden Sensorineural Hearing Loss

“…This may be due to similar underlying vascular pathophysiology between SSNHL and migraine, which is in line with Dogan et al's finding that prophylactic migraine treatment such as topiramate may reduce endothelial pulse wave velocity and also lead to decreased long‐term cardiovascular risks 34 . Topiramate's positive role in regulating cerebrovascular autonomic control has also been speculated 35 . The potential neuroprotective effects of nortriptyline against cerebral ischemia further support these prophylactic medications’ vascular effects, 36 which could explain its observed benefits to patients with migraine as well as SSNHL.…”

“…34 Topiramate's positive role in regulating cerebrovascular autonomic control has also been speculated. 35 The potential neuroprotective effects of nortriptyline against cerebral ischemia further support these prophylactic medications' vascular effects, 36 which could explain its observed benefits to patients with migraine as well as SSNHL. Verapamil, which is another drug commonly used for treating migraine, is also associated with significantly decreased cerebrovascular resistance.…”

Profiling cerebrovascular function in migraine: A systematic review and meta-analysis

“…and Karadas et al. found migraineurs to have higher MBFV in the posterior circulation compared to controls; 21,33,41 the remaining 13 studies were not able to detect a significant difference in MBFV between migraineurs and controls. 12 , 19,20,23–26,29,35,45–47,49…”

“…Sixteen studies compared MBFV in the posterior circulation of migraineurs and controls. 12 , 19–21,23–26,29,33,35,41,45–47,49 Abernathy et al., Chernyshev et al. and Karadas et al.…”

“…Thirty-five studies were identified from the literature search that compared resting mean blood flow velocity (MBFV) in migraineurs to controls; 12,16–49 30 studies assessed MBFV in the anterior circulation. 12,19–24,26–32,34–49 All but four studies found no significant difference in MBFV in the anterior circulation between migraineurs and controls; Abernathy et al., Fiermonte et al., Karadas et al. and Kastrup et al.…”