E-Pearl of the Week: The efficacy and safety of propranolol added to topiramate in chronic migraine prophylaxis

March 28, 2012


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March 28, 2012

The efficacy and safety of propranolol added to topiramate in chronic migraine prophylaxis

The diagnosis of chronic migraine requires 15 or more headache days per month for 3 months, with at least 8 headache days per month that meet criteria for migraine without aura or that respond to migraine–specific treatment. In this week's issue, Silberstein et al. report the results of a double–blind, placebo–controlled, randomized clinical trial that enrolled chronic migraine subjects with ≥ 10 headaches/month treated with topiramate (50–100mg/day) to receive either extended release propranolol or placebo. Of the 191 subjects that were randomized, the reduction in the moderate–to–severe 28–day headache rate for the last 4 weeks compared to the baseline 4 weeks for combination therapy versus topiramate alone was not significantly different, with values of 4.0 days in the combination therapy and 4.5 days in the topiramate only group.


1. Silberstein SD, Dodick DW, Lindblad AS, et al. Randomized, placebo–controlled trial of propranolol added to topiramate in chronic migraine. Neurology 2012; 78: 976–984.
2.┬á Bigal ME, Serrano D, Reed M, Lipton RB. Chronic migraine in the population: burden, diagnosis, and satisfaction with treatment. Neurology. 2008 Aug 19; 71: 559–566.

Submitted by: Stacey L. Clardy, MD, PhD
Disclosures: Dr. Clardy serves on the editorial team for the Neurology® Resident and Fellow Section.

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