Topiramate administration decreases body weight and preserves lean body mass in hemicranic women

Background & aims: Topiramate administration is effective in preventing migraine episodes, and induces significant weight loss, but results on its effects on body composition are controversial. Methods: Female, migraine patients, aging 25-55 years, without concomitant preventive anti-migraine therapy, were considered for the study. Patients with type 2 diabetes, hypertension or thyroid disease were excluded. Topiramate was titrated (25 mg weekly) to a target dose of 100 mg/day. During the 24-week study period, patients maintained their usual diet and lifestyle. Patients were followed up at 1, 3, and 6 months, and their body weight recorded. Body composition was investigated by the DEXA scan technique at the beginning and at follow-up visits. The number of monthly migraine episodes and their severity was also assessed. Results: Thirty patients were enrolled in the study. Five patients did not complete the study, mostly because of adverse events. In the 25 completers, body weight significantly declined (67.6 ± 13.3 kg at the end of the study vs 75.0 ± 11.1 kg at baseline; p < 0.01), due to a selective reduction of fat mass. At the end of the study, 80% of patients (n = 20) reported complete resolution of migraine. Conclusions: Topiramate 100 mg/day is well tolerated, and significantly reduces body weight by selectively reducing fat mass, while simultaneously preventing/ameliorating migraine episodes. © 2009 European Society for Clinical Nutrition and Metabolism.