Zonisamide is effective in the preventive therapy of chronic migraine

Introduction

Topiramate is the only approved oral preventive drug for chronic migraine (CM). However, we usually use other preventive drugs of prevention of frequent episodic migraine. Zonisamide is a neuromodulator that has showed efficacy in prevention of CM.

Objectives

To evaluate the efficacy of zonisamide after three months of therapy in CM patients (IHS-2006 criteria) that present inefficacy/intolerance/contraindication to topiramate, sodium valproate, â-blocks and flunarizine.

Methods

Doses ZNS: 50-200mg. Primary end-point: Number of migraine days-NMD: Ineffective response-Inef(reduction of days<50%), good-G(50-75%), excellent-Exc(>75%). Secondary end-points: number of migraine episodes-NME; number of headache days-NHD; drug overuse; consumption of triptans and NSAIDs; EVA and MIDAS score, effective mean dose of ZNS, adverse events.

Results

We prospectively included 27 patients (May 2011-May 2012), 85.2% women. Twelve patients (44.4%) presented 16 adverse events (100% mild). Four of them-14.8% left the therapy. NMD, in the 23 patients who finished the three months follow-up, was Exc-39.1%, G-43.5%, and Inef-17.4%; NME was Exc-30.4%, G-43.5%, and Inef-26.1%; and NHD was Exc-34.8%, G-39.1%, and Inef-26.1%. Drug overuse disappeared in 47.8% of overusers. The consumption of triptans and NSAIDs decreased 54.3%, and 65.7%. The EVA score decreased 3.7 points (56.2%), and MIDAS scale score decreased 14.6 points (48.7%). Effective mean doses of ZNS: 106.6mg/night.

Conclusion

Zonisamide presents a good profile of efficacy (70.3% of responses) and an acceptable tolerance. It could be a useful therapeutic option in CM patients intolerants, refractory, or with contraindications for topiramate, and the other drugs preventive drugs of migraine.