THE EFFECT OF PREVENTIVE TREATMENT WITH
TOPIRAMATE IN CHRONIC MIGRAINE
PSYCHIATRIC COMORBIDITY
G033
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Peres MFP, Mercante JPP, Tanuri FC, Zukerman E
Instituto Israelita de Ensino e Pesquisa Albert Einstein. São Paulo Headache Center
INTRODUCTION. Psychiatric comorbidity in chronic migraine (CM) is one of the most
important management issues. Anxiety and depression can be found in up to 75% of cases.
Little is known about the effect of migraine preventive treatment in comorbid disorders.
OBJECTIVES. To analyze the effect of chronic migraine prevention with topiramate in
psychiatric comorbidity.
METHODS. Sixty-four patients were enrolled in the study. Fifty patients completed criteria for
analysis. An intention-to-treat method was used for the analysis. All patients met diagnostic
criteria for chronic migraine according to the IHS-2004. Eighty-four percent of patients had at
least one DSM-IV diagnosis, 76% anxiety, 50% mood disorders. Trait-state anxiety, HAManxiety, HAM-depression, and Beck scores were used at baseline, titration, and follow-up
visits.
HAM-D
Be ck
20
18
25
16
20
14
12
15
10
10
8
6
5
4
0
S1
baseline
mês 1
mês 2
2
mês 3
0
S1
baseline
mês 1
mês 2
mês 3
Headache Frequency
dias com dor
30
25
20
15
10
5
0
0
1
2
3
4
5
mês de tratamento
50
48
HAM-A
46
44
20
15
10
5
0
42
40
38
36
IDATE traço
1
2
3
4
IDATE estado
RESULTS. Frequency, intensity, and duration of migraine attacks were significantly reduced.
Mood and anxiety scales significantly reduced (p<0,001) with topiramate treatment (median
dose 100mg), when compared the initial visit with month 1, 2, and 3 data. The effect was
already significant (p<0,001) at the first month of treatment.
CONCLUSION. Patients with chronic migraine and psychiatric comorbidity treated with
Topiramate reduced significantly their anxiety and depression levels in addition to their
migraine attacks.