Efficacy and tolerability of melatonin - versus topiramate in migraine prevention - REVISTA AVFT.COM
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Efficacy and tolerability of melatonin
versus topiramate in migraine prevention
Eficacia y tolerabilidad de la melatonina frente al topiramato en la prevención de la migraña
Waseem H. Alkhaffaf1, Akram M. Al.mahdawi2
1
lecturer (Board Certificate in Neuromedicine) / Dept. of Medicine / college of medicine/ Ninevah University/ Mosul, Iraq; email: waseem.qasim@uoninevah.edu.iq
2
Consultant Neurologist, Baghdad teaching hospital/ Medical City Chairman of Iraqi Neurology Council, Chairman of Iraqi neurology society. email:
akramalmahdawi@gmail.com
Corresponding author: Waseem H. Alkhaffaf, lecturer (Board Certificate in Neuromedicine)/ Dept. of Medicine / college of medicine/Ninevah University/ Mosul, Iraq.
Mobile: 009647702010315. Postal Code: 41001. email: waseem.qasim@uoninevah.edu.iq
AVFT Archivos Venezolanos de Farmacología y Terapéutica
Received/Recibido: 12/28/2020 Accepted/Aceptado: 01/15/2021 Published/Publicado: 02/10/2021 DOI: http://doi.org/10.5281/zenodo.4660433
Abstract Resumen
Volumen 40, número 1, 2021
Background: Migraine is one of the common neurological Antecedentes: la migraña es una de las enfermedades
diseases. the aims of this study are to compare the effective- neurológicas más frecuentes. los objetivos de este estudio
ness and tolerability of Topiramate and Melatonin drugs as son comparar la eficacia y la tolerabilidad de los fármacos
monotherapy in the prophylaxis of migraine and to support topiramato y melatonina como monoterapia en la profilaxis
the use of Melatonin as a preventive therapy. de la migraña y apoyar el uso de melatonina como terapia
preventiva.
Materials and Methods: a prospective, comparative study,
in which 200 Patients diagnosed with migraine were enrolled. Materiales y métodos: estudio prospectivo, comparativo, en
Monthly headache frequency, headache severity, mean at- el que se inscribieron 200 pacientes diagnosticados de mi-
tack duration in hours, and disability, were assessed at the graña. La frecuencia mensual de los dolores de cabeza, la
baseline and at the end of 3rd month of follow up. Tolerability gravedad del dolor de cabeza, la duración media del ataque
measures including the incidence of adverse events were re- en horas y la discapacidad se evaluaron al inicio y al final
corded also. del tercer mes de seguimiento. También se registraron las
medidas de tolerabilidad, incluida la incidencia de eventos
Results: Forty patients withdrew from the study, the anal- adversos.
ysis was performed for the remaining cases, 160 patients, 27
(76 in topiramate group and 84 in melatonin group). There Resultados: Cuarenta pacientes se retiraron del estudio, el
was a significant improvement in the clinical response after 3 análisis se realizó para los casos restantes, 160 pacientes,
months of treatment in all parameters, and without significant (76 en el grupo de topiramato y 84 en el grupo de melato-
differences between both groups. nina). Hubo una mejora significativa en la respuesta clínica
a los 3 meses de tratamiento en todos los parámetros, y sin
Conclusion: this study showed that the Melatonin is effective diferencias significativas entre ambos grupos.
as, if not superior to, Topiramate for episodic migraine pro-
phylaxis. Moreover, it is more tolerated and has less adverse Conclusión: este estudio mostró que la melatonina es efi-
events than Topiramate. caz, si no superior, al topiramato para la profilaxis de la mi-
graña episódica. Además, es más tolerado y tiene menos
Key words: Migraine, Topiramate, Melatonin. efectos adversos que el topiramato.
Palabras clave: migraña, topiramato, melatonina.
Introdution
Migraine is one of the common neurological diseases and it is Effective treatment of migraine starts with making a correct
characterized by throbbing unilateral headache attacks, that diagnosis, excluding the alternate causes, addressing the
are associated with phonophobia, photophobia, nausea, and impact on the patient’s life and educating the patient regard-
vomiting, and it is exacerbated by physical activity1. ing therapeutic options, treatment duration, adverse effects
www.revistaavft.com- Exclusion Criteria
agement2.
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ity, or duration3 -
patient.
2
.
4. Any Pregnant and lactating woman.
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-
-
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patic, or respiratory diseases.
-
1
. dergoing treatment.
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2
.
Topiramate
in adults4.
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s
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.
28 7
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8
.
Materials and Methods
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st
ten
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Disorders, experiencing test, paired and unpaired-t-test were used.Demographic data -
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Table 2. Comparison of headache characteristics before and after
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Topiramate Melatonin
Group data Before after Before after
P P
treatment treatment treatment treatment
value* value*
(mean±SD) (mean±SD) (mean±SD) (mean±SD)
monthly
Archivos Venezolanos de Farmacología y Terapéutica
headache 7.07 ± 2.56 3.82±1.97 0.000* 6.77±2.57 3.71±1.88 0.000*
frequency
Severity of
3.80 ± 1.63 2.57±1.54 0.000* 4.03±1.67 2.49±1.47 0.000*
headache
Headache
duration in 10.38±11.68 6.71 ± 7.47 0.017* 9.92 ± 11.04 6.27 ± 6.68 0.008*
Volumen 40, número 1, 2021
hours
Headache
disability: 13.68±7.75 10.16±7.67 0.003* 14.28 ± 7.63 10.00±7.41 0.000*
MIDAS
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Table 3. Comparison of clinical response in both groups
AVFT
Table 1. Comparison of characteristics of patients in groups Before treatment After treatment
Group data Total Topiramate Melatonin P value* Topiramate Melatonin Topiramate Melatonin
Group data (n=100) (n=100) P (n=76) (n=84) P
N. 200 100 100 value* value*
Age in years (mean±SD) (mean±SD) (mean±SD) (mean±SD)
31.36±9.53 31.77± 9.48 30.95 ± 9.61 0.544
(mean ± SD) 29
monthly
Onset age of headache 7.07±2.56 6.77±2.57 0.409 3.82±1.97 3.71±1.88 0.718
migraine (mean 24.92±8.68 25.67± 8.63 24.17± 8.70 0.222 frequency
± SD)
Severity of
Monthly 3.80±1.63 4.03±1.67 0. 325 2.42±1.48 2.38±1.43 0.737
headache
headache
6.92±2.56 7.07 ± 2.56 6.77 ± 2.57 0.409 Headache
frequency
(mean ±SD) duration in 10.38±11.68 9.92±11.04 0. 775 6.71±7.47 6.27±6.68 0.694
hours
Severity of
headache 3.92±1.65 3.80 ± 1.63 4.03 ± 1.67 0.325 Headache
(mean ±SD) disability: 13.68±7.75 14.28±7.63 0.581 10.16±7.67 10.00±7.41 0.893
Headache MIDAS
duration in
10.15±11.34 10.38 ± 11.68 9.92 ± 11.04 0.775
hours (mean
±SD)
Headache
disability:
13.98±7.68 13.68 ± 7.75 14.28 ± 7.63 0.581
MIDAS (mean
±SD)
Sex M 64 34 30 0.54
F 136 66 70
www.revistaavft.com-
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- Discussion
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.
and melatonin groups
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Topiramate Melatonin -
The responder rate (%) (%) 84
76 (100%) (100%)
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0.57
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0.52 -
11
.
:
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tions as well as treating clinicians, most clinicians accept ev-
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12
.
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30
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Topiramate Melatonin
Side effects
(N=76)(%) (N=84)(%)
13,14
Sleepiness 15(19.7) 15(17.8) 0.760 ,
Dizziness 7(9.2) 10(11.9) 0.580 -
Paresthesia 30(39.4) ------ 0.000*
Anorexia 13(17.1) ------ 0.000*
Fatigability 7(9.2) 5(5.9) 0.434
Dry mouth 2(2.6) ------ 0.134
Diarrhea 3(3.9) ------ 0.066 -
Worsening headache 3(3.9) 1(1.1) 0.264
Constipation ------ 1(1.1) 0.340
concentration/attention
10(13.1) 3(3.5) 0.026* -
Tremor 3(3.9) ------ 0.066
(Long R et al,2018; Gonçalves AL et al, 2016; Peres M et
-
--
al, 200416
Topiramate as in Freitage, 200317
13
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21,22
6,10
2,6
-
9 23
- .
Archivos Venezolanos de Farmacología y Terapéutica
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tonin in treating migraine patients.
Volumen 40, número 1, 2021
Conclusion
20179 18
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including socioeconomic matters.
AVFT
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Statement on Integrating New Migraine Treatments into Clinical
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. Neto J, Peres MF. Randomised clinical trial comparing melatonin
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neur.61.4.490 -
CAPSS-277 Investigator Group. Topiramate versus amitriptyline in
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