Pilot Study to Compare Frovatriptan vs. Topiramate for Prevention of Migraine
Condition: Migraine
MeSH terms: Migraine Disorders
Intervention: topiramate; frovatriptan
Intervention description: topiramate 25mg 1 tab in PM x 1 week topiramate 25mg 1 tab in AM / 1 tab in PM x 1 week topiramate 25mg 1 tab in AM / 2 tabs in PM x 1 week topiramate 25mg 2 tabs in AM / 2 tabs in PM x 5 weeks; frovatriptan 5mg tab during premonitory phase of migraine
Intervention MeSH terms: Topiramate; Frovatriptan
Phase: Phase 4
Study type: Interventional
Primary purpose: Prevention
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Enrollment: 55.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: Accepts Healthy Volunteers
Keywords: Migraine; Migraine prevention; Prodrome; Premonitory phase; Preemptive therapy

Summary:

      Subjects enrolled at 2 investigative sites will complete 3 visits. Following Visit 1, during
      a 1-month Baseline Period, subjects will treat with their usual medication and document any
      warning signs (Prodrome pre-headache) that a migraine will occur. Following randomization
      (like a flip of the coin) at Visit 2, subjects will treat daily with topiramate or during
      Prodrome with frovatriptan. Subjects complete a 2-month Treatment Period before exit at Visit
      3.This study will compare the effectiveness of daily treatment vs. treatment during the
      pre-headache phase for prevention of migraine.
    

Eligibility criteria:

        INCLUSION CRITERIA

          1. Subject has at least a one-year history of migraine with or without aura meeting
             International Headache Society criteria (see Appendix)

          2. Subject has a 3-month history of averaging 3-6 migraines per month

          3. Subject reports premonitory symptoms and the ability to predict at least 50% of high
             impact headaches

          4. Subjects must currently or have in the past successfully utilized a triptan as an
             acute treatment for migraine as determined by the investigator.

          5. Male or female at least 18 years of age

          6. Subject of childbearing potential agrees to use adequate contraception during the
             study. Adequate methods of contraception are to be determined by the investigator and
             should be consistent with contraceptive care administered in the regular clinical use
             of frovatriptan and topiramate.

          7. Subject is aware of prodrome symptoms that may include physiological, psychological or
             cognitive changes. These may include, but are not limited to such symptoms as
             Pre-Menstrual Syndrome (PMS), change in mood, energy level, appetite, food craving,
             nausea, sense of hearing, sense of smell or swelling/fluid retention, excessive
             yawning, head pain, muscle pain/tenderness, irritability, confusion, extreme
             sleepiness, impaired speech or impaired memory. (The subject should be able to
             differentiate these symptoms from other similar symptoms that do not precede
             migraine). The symptoms should precede migraine by 4-24 hours signaling an impending
             migraine attack.

          8. Subject is able to understand instructions for the study and complete the diary

          9. Subject is willing to give informed consent to participate in the study

         10. Any migraine prophylactic medication must have a stabilized dosage for one month

        EXCLUSION CRITERIA

          1. History of any medical condition that would confound the results of the study
             including but not limited to the following:

               -  Hepatic disease or significant hepatic dysfunction

               -  History of pancreatitis

               -  History of thrombocytopenia

               -  History of glaucoma

               -  History of osteoporosis or osteopenia

               -  Cardiovascular Disease - Coronary artery disease, Ischemic heart disease or
                  Significant Arrhythmia

               -  History of active Cerebrovascular Disease

               -  Hypertension - Uncontrolled hypertension in a non-migrainous state (> 160 mmHg
                  systolic or >95 mmHg. diastolic). Hypertension must be controlled effectively
                  with medication for a period of 3 months.

               -  Basilar or Hemiplegic Migraine

               -  Significant peripheral vascular disease or Raynaud's Syndrome

               -  Significant Active Renal, Hepatic, Gastrointestinal, Endocrine or

               -  Neurological Disease

               -  History of depression, mood problems or suicidal thoughts or behavior that in the
                  opinion of the Investigator would interfere with participation in the study.

          2. History of ergotamine, "triptan", or analgesic abuse within past 3 months

          3. History of current or recent drug or alcohol abuse that would interfere with
             participation in the study.

          4. More than 15 headache days per month within past 3 months.

          5. Women who are pregnant or breast feeding

          6. Subjects with known hypersensitivity or intolerance to topiramate or any triptan-like
             medication

          7. Subject is scheduled for surgical procedure to occur while enrolled in study.that in
             opinion of the Investigator would interfere with participation in the study.

          8. Subject is on a ketogenic diet

          9. Participation in another investigative drug study within the previous 30 days

         10. Excluded medications: MAO Inhibitors, lithium, methylergonovine, methysergide,
             ergotamine-containing products, or topiramate daily for migraine prophylaxis.