Digest

Abstract

AbstractMigraineMigrainous vertigoMigraine and vertigo may occur together but there is little evidence to show whether drug treatment is effective. Investigators from Turkey have now evaluated prophylaxis with topiramate 50 or 100mg daily in 30 women meeting published criteria for ‘migrainous vertigo’ in whom Meniere's disease had been excluded (Headache 2010;50:77–84).Over 24 weeks, topiramate reduced the mean frequency of vertigo attacks compared with pretreatment levels from 8.1 to 2.3 per month and headache frequency from 5.2 to 2.0 per month; it also reduced the severity of both vertigo and headache. There were no significant differences between doses. Adverse effects were common (paraesthesias, fatigue, impaired memory and concentration and decreased appetite), leading four women to discontinue treatment.Dependence with acute treatmentsAn analysis of the French national pharmacovigilance database suggests that the risk of dependence with acute treatments for migraine may be comparable with that of the benzodiazepines (Eur J Clin Pharmacol 2009; DOI 10.1007/ s00228‐009‐0769‐6).Between 1985 and 2007, the French equivalent of the yellow card database received 449 spontaneous reports of suspected adverse reactions associated with triptans and 332 with ergot derivatives. Dependence accounted for 11 and 9 per cent of these respectively.The odds ratio of dependence with the triptans was 15 and that for ergot derivatives was 13. There were differences within each group. The odds ratio was 10 for sumatriptan and 21.5 for eletriptan; for ergot amine it was 12 and for dihydroergot amine it was 21. To confirm the methodology, the risk associated with negative and positive controls was also calculated: for amoxicillin the odds ratio was 0.1 and for the benzodiazepines it was 10.The authors acknowledge the risk of bias inherent in using a spontaneous reporting scheme to estimate risk (under‐reporting, notoriety) but say their findings support the hypothesis that acute migraine treatments are associated with dependence. Copyright © 2010 Wiley Interface Ltd