A blinded study comparing Botox with Topamax for the prevention of migraine headaches was conducted by Drs. Jaffri and Mathew and published in the current issue of Headache. They enrolled 60 patients and divided them into two groups – one group received real Botox and placebo tablets, while the second group received saline water injections instead of Botox, but were given tablets of Topamax. At the end of 9 months and after 2 Botox treatments the efficacy of these two treatments was the same, but many more patients in the Topamax group developed side effects and dropped out of the study.
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Imitrex and Topamax are two migraine medications that recently lost their patent protection and became available in a generic form, under the names of sumatriptan and topiramate. Many patients are concerned about the quality of generic products. A recent study published in Neurology looked at 948 patients with epilepsy who were treated with generic Topamax (it is approved for the treatment of both migraines and epilepsy). Compared to patients who used the branded Topamax, those on generic substitutions needed to have more of other medications, were admitted to the hospital more frequently and stayed in the hospital longer. The risk of head injury or fracture (presumably due to seizures) was almost three times higher after the switch to a generic drug.
Clearly, migraine patients do not run the same risk as epilepsy patients of having a seizure or being admitted to the hospital, however a small number of patients can have worsening of their migraines. The main reason is the legally permitted variation in the amount of medicine in each tablet. Taking a higher dose of the generic drug can help.
The same applies to Imitrex – a small number of patients will find that the generic sumatriptan is slightly less effective. The only, albeit significant, advantage of the generic drugs is cost savings. At this point we have only one generic substitution for Imitrex and the price difference is only 20%, but in a few months more generics will appear and the price should drop significantly, which is a very welcome development for patients with frequent migraines.
Read MoreTopamax is a popular drug for the prevention of migraine headaches. IT works for about half of the patients who try it. The main problem that makes people stop taking the drug is cognitive side effects. Patients tell us that they feel “stupid” on this drug. An article just published in the European Journal of Neurology pinpoints the main cognitive problem, which turns out to be word fluency. This means having trouble coming up with the right word.
Read MoreThis is a common question people ask when we suggest that they start taking a daily preventive medication. A groundbreaking study just published by Hans-Christoph Diener and his colleagues answers this question. Over 800 patients were placed on topiramate (Topamax), a popular epilepsy drug used to treat headaches. After 26 weeks half of the patients were switched to placebo and the other half contined on Topamax for another 26 weeks without doctors or patients knowing who was taking what.  It turns out that stopping Topamax did worsen headaches, but not that much – in a 28-day period those on Topamax had one fewer day with migraine than those on placebo. This suggests that what most headache specialists have suspected from their experience all along is correct. That is many patients can stop taking their daily medication after about six months without significant worsening. However, there are some patients who may need to stay on a medication for longerer periods of time.
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