Low versus high doses of topiramate in the preventive treatment of migraine

Introduction. The efficacy of topiramate in the preventive treatment of migraine is well demonstrated. Clinical trials indicate that the close of 100 mg/daily is the ideal in terms of efficacy, but doses as low as 50 mg/ daily show some efficacy, which could improve its tolerability in some patients. Objetive. To analyse the behaviour of the different doses of topiramate in daily clinical practice. Patients and methods. Patients with frequent migraine with or without aura episodes who received topiramate in our clinic were treated in a homogeneous way. Initially they were given 50 mg/daily (Usually as a nocturnal (lose), after increasing the dose in 2-3 weeks. The efficacy was evaluated after 6-8 weeks. If no response (decrease in frequency by at least 50%) was observed the close of topiramate was increased (25 mg/week) up to 100 mg/daily, The patients were seen at least once every 3 months. Results. This series includes 182 patients. Globally, 75% of the patients responded, 14% did not respond and 11% did not tolerate the drug. One-quarter of patients (44 cases) responded to low doses, while 92 patients (51 No) responded to the 100 mg/dose. Tolerability slightly decreased on increasing the (lose. Conclusions. These data indicate that one-quarter of the. patients respond to low (loses in daily clinical practice, though about half of these patients will need doses of 100 mg/day. Given the higher tolerability of low (loses, we recommend trying First low (loses before giving higher doses, which will be necessary in half of the patients.