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Academia Mexicana de Neurología, A.C.

2010, Number 5

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Rev Mex Neuroci 2010; 11 (5)

Topiramato vs. Amitriptilina en el tratamientoprofiláctico de la migraña: Ensayo clínico controlado

Rodríguez-Leyva I, Sánchez-Aguilar M, Hernández-Sierra JF, Mandeville PB, Rodríguez LMR, Shiguetomi-Medina JM, Tapia-Pérez JH

Language: Spanish
References: 69
Page: 338-342
PDF size: 40.08 Kb.


ABSTRACT

Antecedentes: La cefalea relacionada con la migraña es un problema frecuente en la práctica médica, el tratamiento comienza por la identificación de agentes desencadenantes para evitarlos. La siguiente etapa es el manejo de la cefalea aguda y la tercera, consiste en la elección del mejor tratamiento profiláctico para cada paciente. Objetivo: Comparar la eficacia y costo de la amitriptilina vs. el topiramato como tratamiento profiláctico para la migraña. Pacientes y métodos: Ensayo clínico controlado que compara la frecuencia e intensidad de la cefalea migrañosa entre pacientes que recibieron topiramato vs. amitriptilina (18 en cada grupo), utilizando como medición la Evaluación de Discapacidad de la Migraña (MIDAS, por sus siglas en inglés). Estas mediciones fueron realizadas antes y después del tratamiento profiláctico por cuatro meses en ambos grupos. También se compararon los efectos adversos así como la respuesta al ketorolaco en cada grupo para el manejo agudo de la migraña. Resultados: Se encontró reducción estadísticamente significativa en la frecuencia e intensidad del dolor migrañoso en ambos grupos (p‹0.007), sin diferencias entre ambos grupos. La frecuencia de efectos colaterales fue mayor para el grupo de topiramato (n=69) que para el grupo de amitriptilina (n=43)(p‹0.001). El aumento de peso fue el efecto indeseable más frecuente en el grupo que recibió amitriptilina mientras que la pérdida de peso lo fue para el topiramato. Conclusión: El topiramato y la amitriptilina son tratamientos profilácticos efectivos en el tratamiento profiláctico para la migraña. La elección del fármaco debe hacer de acuerdo a las características del paciente y posibilidades económicas.


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