Study compared the two agents and found their effects comparable except topiramate offered better some quality of life
Clin Ther. 2009 Mar;31(3):542-59.
Topiramate versus amitriptyline in migraine prevention: a 26-week, multicenter, randomized, double-blind, double-dummy, parallel-group noninferiority trial in adult migraineurs.
Dodick DW, Freitag F, Banks J, Saper J, Xiang J, Rupnow M, Biondi D, Greenberg SJ, Hulihan J;
- 8 weeks was washout and baseline
- 4 weeks was spend increasing doses of the drugs: – started at 25 mg and increased by 25 mg a week to max 50 mg BID – minimum dose 50 mg/day
- after 12 weeks of drug – assessment – then 4 weeks after too
Didn’t seem to do much for headache severity but frequency was near 1/2 for either. Topiramate gave better quality of life though one would wonder if that was because they tried to give amitriptyline during the day!
Comment – I would never start anyone on 25 mg amitriptyline – with chronic pain patients who are fed up with pills you only have one chance – they react badly – it’s out. Start at 10 mg though it is temporarily unavailable here now… Amitriptyline should be given all at bedtime and I will continue to do so. – same with topiramate. Topiramate has been called the “stupid pill” because it causes cognitive dysfunction – I would avoid it in people taking classes. I also mention the 2% kidney stone rate…
addendum:
Adding propranolol to topiramate does not help:
Randomized, placebo-controlled trial of propranolol added to topiramate in
chronic migraine
S.D. Silberstein et al
Neurology 2012; 78:976–984
http://www.ohioupsychology.com/files/images/holroyd_lab/Silberstein%20et%20al%20%282112%29Neurology_976-84.pdf
Topirimate comes in a 12.5 mg sprinkle capsule for kids with seizures – start with that if have trouble tolerating.
