The Medical Letter on Drugs and Therapeutics
Topiramate (Topamax) for Prevention of Migraine
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Patients with frequent, severe or disabling migraine headaches may benefit from taking a drug to prevent the attacks. Beta-blockers traditionally have been the prophylactic treatment of choice, but in recent years some antiepileptic drugs such as valproate (Depakote, and others) and topiramate (Topamax) have also been used for this indication.Valproate was approved by the FDA for such use in 1996. Now topiramate has also been approved.

OTHER DRUGS — Propranolol and timolol are the only beta-blockers approved by the FDA for prevention of migraine, but metoprolol (Lopressor, and others), nadolol (Corgard, and others) and atenolol (Tenormin, and others) have been used as well.1 Beta-blockers can cause fatigue, exercise intolerance, depression, orthostatic hypotension and decreased libido. All are relatively contraindicated in patients ... more      

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