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Two center, randomized pilot study of migraine prophylaxis comparing paradigms using pre-emptive frovatriptan or daily topiramate: research and clinical implications
Headache: The Journal of Head and Face Pain,  Clinical Article

Cady RK et al. – This pilot study demonstrated that statistical benefit for reduction of headache days over baseline for both pre–emptive frovatriptan and daily topiramate. Subjects utilizing pre–emptive frovatriptan experienced fewer adverse events leading to study withdrawal. Subjects utilizing daily topiramate had fewer headache days at Month 2.

Methods
  • A total of 76 adult subjects with a diagnosis of migraine were screened for the study.
  • During a 1–month baseline period, subjects demonstrated through a daily diary that they predicted at least 50% of migraine attacks during the premonitory phase and treated with their usual medication.
  • Of these, 55 were randomized to either Group A (daily topiramate) or Group B (frovatriptan during premonitory symptoms); 44 completed the study.
  • The treatment period lasted 2 months.
  • The subjects answered the Migraine–Specific Quality of Life Questionnaire at randomization, and at Weeks 4 and 8.
  • The revised Patient Perception of Migraine Questionnaire was answered 24 hours after taking frovatriptan (Group A, for break–through headaches; Group B, treatment during premonitory symptoms).

Results
  • The number of migraine attacks and headache days per month decreased significantly from baseline for both Groups A and B.
  • Subjects in Group A had considerably more adverse events leading to study withdrawal than in Group B (18% vs 4%).
  • Though this study was not powered to directly compare the efficacy of the 2 drugs, topiramate showed superiority over frovatriptan at Month 2 in reduction of headache days, which was a secondary end point in the study (P = .036).

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