The Efficacy and Tolerability of Topiramate in Migraine Prophylaxis in CFS/ME Patients

Tarek Gaber, Danielle Cooper and Wilma Hudson

Department of Neurological Rehabilitation, Bridgewater Healthcare NHS Trust, UK
Department of Occupational Therapy, Bridgewater Healthcare NHS Trust, UK

^*Correspondance to: Tarek Gaber 

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Abstract:

Background: More than 80% of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) patients suffer from migraine. Topiramate is a first line agent for migraine prophylaxis; however 25% of migraine sufferers are unable to tolerate its side effects. Topiramate can cause fatigue and cognitive dysfunction mimicking the symptoms of CFS/ME therefore there is uncertainty if this group is able to tolerate Topiramate.
Aim: To evaluate the efficacy and tolerability of Topiramate in Migraine prophylaxis in CFS/ME patients
Design: A retrospective study.
Methods: Data was gathered from two specialist CFS/ME rehabilitation services who serve a population of >600.000 in the north of England. Patients started on Topiramate for migraine prophylaxis were contacted and their feedback regarding Topiramate including current dose, efficacy, side effects and reason for withdrawal if appropriate were noted.
Results: 27 patients were started on Topiramate. 24 were females with a mean age of 37 (SD27). The dose ranged between 25 mg to 125 mg with mean 79 mg daily. 5 patients (18.5%) could not tolerate Topiramate because of increasing fatigue; cognitive side effects and paresthesia. 3 patients had side effects of self-limiting paresthesia and continued with the medication. All remaining 22 patients reported improvement in their migraine frequency: 10 (39%) with no attacks, 9 (33%) experienced more than 50% reduction and 3 (17%) experienced less than 50% reduction.
Discussion: Our cohort of patients with CFS/ME experienced better response rate and tolerability compared to the reported pooled data from RCTs. Concern regarding intolerance and side effects of Topiramate in CFS/ME patients suffering from migraine is unjustified. Offering clear clarification of the benefits, explanation of potential side effects and providing ongoing support may explain these positive results.

Keywords:

Topiramate; Chronic fatigue syndrome; Myalgic encephalomyelitis; Migraine

Cite the Article:

Gaber T, Cooper D, Hudson W. The Efficacy and Tolerability of Topiramate in Migraine Prophylaxis in CFS/ME Patients. Clin Case Rep Int. 2018; 2: 1041.