Lampl C et al. (2006) A prospective, open-label, long-term study of the efficacy and tolerability of topiramate in the prophylaxis of chronic tension-type headache. Cephalalgia 26: 1203–1208

Drugs currently used for treating chronic tension-type headache only reduce headache frequency by about a third and are associated with side effects. Topiramate, an antiepileptic drug with potential mechanisms of action including sodium channel blockade, inhibition of glutamate receptors, and enhancement of γ-aminobutyric acid (GABA)A receptors, has proven efficacy and tolerability in migraine. In a prospective open-label study, Lampl and co-workers have shown this drug to have promise in the prophlyaxis of chronic tension-type headache.

Of the 51 patients enrolled, 46 completed 24 weeks of treatment with topiramate (titrated from 25 mg daily at study start to 100 mg daily by week 4 of treatment). The frequency of headache declined significantly at weeks 13–24 compared with baseline (12.58 ± 6.28 days vs 23.50 ± 5.32 days; P <0.0001), with 73% of patients experiencing a 50% reduction in headache frequency. The frequency of severe headaches also decreased significantly (P <0.0001). On the visual analog scale, average headache intensity dropped from 6.13 to 2.07 (P <0.0001). Mood, sleep, quality of life and Beck Depression Inventory II score also all improved significantly during the study period (P <0.0001 for all). Patients experienced few side effects (none of which were severe) and lost a mean 2.14 kg in weight between baseline and week 24 (P <0.0001), overcoming the problem of weight gain seen with some other prophylactic therapies.

Topiramate would thus seem to be highly effective in preventing chronic tension-type headache, with a more-favorable side effect profile than other available treatments. These preliminary results, however, require further validation.