Topiramate could potentially effective as prophylaxis for
cluster headache, but the experience remains limited in Asians. We performed an open-label clinical study to evaluate the efficacy of
topiramate in the tolerable dosage to prevent
cluster headache. We studied patients who fulfilled the criteria of episodic or
chronic cluster headaches (International Classification of
Headache Disorders second edition) prospectively.
Headache severity was assessed using a verbal rating scale (excruciating, severe, moderate, mild, and no
headache). Treatment was started with a
topiramate dose of 50 mg twice daily and was increased by 50-100 mg a day every 3 to 7 days as tolerated to a maximal daily dosage of 400 mg. Of the 12 patients with
episodic cluster headache, nine patients had remission of
headache at a mean daily dosage of 273 mg (range 100-400 mg), and the patient with
chronic cluster headache had remission at a daily dosage of 400 mg. The adverse effects included:
paresthesia (84%), slow speech (54%), and
dizziness (46%), but were tolerated by most patients. Two patients discontinued
topiramate due to adverse events and one due to lack of efficacy. This open-label study suggests that
topiramate is effective in the treatment of
cluster headache in Taiwanese patients.