Efficacy of Topiramate Over Nortriptyline as Monotherapy — Migraine Prophylaxis

Abstract

Introduction: Migraine is a chronic neurologic disease characterized by attacks of throbbing, often unilateral headaches that are exacerbated by physiological activity and associated with photophobia, phonophobia, nausea and vomiting. Objective: The aim of the study was to assess the efficacy of Topiramate over Nortriptyline as monotherapy for migraine prophylaxis. Methods and Materials: A Randomized controlled trial was done at department of Pharmacology and Therapeutics, Dhaka Medical College, Dhaka, Bangladesh. The total duration of the study was from January 2022 to December 2022. A total of 42 migraine patients were enrolled by block random sampling block of 3, 1:1 design. The patients were divided into two groups. In Group A, 21 patients were treated with Topiramate and in Group B, 21 patients were treated with Nortriptyline for consecutive 3 months. Results: In Group A, highest patients in group30-39 years which occupied (42.9%), in Group B, highest patients in group 20-29 years which occupied (33.3%). Male: Female ratio was 1:9 and 1:4 respectively in Group A and Group B.

Headache frequency in headache days/ month was highest in Group B 12.0(2.0-20.0), duration of headache in hours was highest in Group A 6.0(2.0-24.0). Intensity of headache which was expressed by visual analogue scale (VAS) score were same in Group A and Group B 8.0 (7.0-9.0). After treatment, at the end of 1^st month, median headache frequency was the same (3.0 days/month). At the end of 2^nd month, headache frequency was highest in Group B (2.0 days/month). At the end of 3^rd month, headache frequency was same between two groups (0.0day/month). The reduction of headache frequency was higher (92.90%) in Group A than (90.70%) in Group B. Median duration of headache significantly decreased in two Groups. Maximum decreased in Group A compared to Group B. Regarding comparison of VAS scores before treatment and 3 months of treatment, Proportion of VAS scores significantly decreased in two Groups. Maximum decreased in Group A compared to Group B. The adverse effects profile among the three Groups of study patients during this study period. It was observed that Group B 12(57.1%) had the highest experience of adverse effects. Highest 4(19.0%) patients had experienced sedation in Group A and the lowest 1(4.8%) patient in Group B. Blurring of vision 3(14.3%) patients in Group B. Palpitation 1(4.8%) patients Group B, weakness 1(4.8%) patient in Group A. Conclusion: In migraine patient prophylactic management, the patients who were treated with the Topiramate in the Headache Clinic of Dhaka Medical College showed the statistically significant results in this study with the best efficacy after 3 months of treatment compared Nortriptyline group.