Migraine Prophylaxis With Topiramate and Bone Health in Women
Antiepileptic drugs (AEDs) are commonly used for prevention of migraine headaches. Bone loss is a known complication, particularly associated with use of older AEDs. Topiramate is a newer AED, widely used for migraine prevention, but no evidence is currently available on its effect on bone metabolism. In a clinic-based pilot study, we evaluated bone health by examining biochemical and radiological markers of bone metabolism, in women with migraine. Osteopenia was noted in 53% of the patients and was associated with the duration of exposure to topiramate (P = .04).
Migraine is a primary headache disorder afflicting nearly 30 million individuals in the USA, with a markedly higher prevalence in women compared to men. Migraine is associated with significant disability and frequently requires preventative therapy. Antiepileptic drug (AED) use for migraine prevention is well known and the effectiveness of these medications has been demonstrated in clinical trials. Topiramate is one such broad spectrum AED approved by the US Food and Drug Administration and widely used for prevention of migraine headaches.
With expanding indications for use of AEDs, it is important to recognize the potential long-term adverse effects of some of these agents. Bone loss is a well-known complication of first and second generation AEDs. As yet, there have been no published clinical studies on topiramate use and related affect on bone health in the adult epilepsy or migraine population. Studying this relationship in the epilepsy population is complicated by use of multiple AEDs and the influence of older AEDs. In this pilot study, we aim to evaluate bone health in migraineurs who were being treated with topiramate by examining biochemical and radiological markers of bone metabolism.
Abstract and Introduction
Abstract
Antiepileptic drugs (AEDs) are commonly used for prevention of migraine headaches. Bone loss is a known complication, particularly associated with use of older AEDs. Topiramate is a newer AED, widely used for migraine prevention, but no evidence is currently available on its effect on bone metabolism. In a clinic-based pilot study, we evaluated bone health by examining biochemical and radiological markers of bone metabolism, in women with migraine. Osteopenia was noted in 53% of the patients and was associated with the duration of exposure to topiramate (P = .04).
Introduction
Migraine is a primary headache disorder afflicting nearly 30 million individuals in the USA, with a markedly higher prevalence in women compared to men. Migraine is associated with significant disability and frequently requires preventative therapy. Antiepileptic drug (AED) use for migraine prevention is well known and the effectiveness of these medications has been demonstrated in clinical trials. Topiramate is one such broad spectrum AED approved by the US Food and Drug Administration and widely used for prevention of migraine headaches.
With expanding indications for use of AEDs, it is important to recognize the potential long-term adverse effects of some of these agents. Bone loss is a well-known complication of first and second generation AEDs. As yet, there have been no published clinical studies on topiramate use and related affect on bone health in the adult epilepsy or migraine population. Studying this relationship in the epilepsy population is complicated by use of multiple AEDs and the influence of older AEDs. In this pilot study, we aim to evaluate bone health in migraineurs who were being treated with topiramate by examining biochemical and radiological markers of bone metabolism.
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