Cognitive Effects of Immediate Release Topiramate vs Extended Release Topiramate in Patients With Migraine

The primary objective is to compare the effect of treatment with an immediate-release
topiramate (IR-TPM), namely Topamax®, to an extended-release topiramate (XR-TPM), namely
Trokendi XR®, regimen on cognition in adults with migraine.

The secondary objective is to determine the factors that explain inter-individual variability
in cognitive response. Pharmacokinetic and demographic factors will be explored. Variability
in cognitive response between individuals can be large. A population approach (nonlinear,
mixed effects) will be used to determine drug exposure response relationships.

Inclusion Criteria:

1. Established history of episodic migraine with or without aura, as assessed by
International Headache Society criteria, for at least 6 months before screening and
frequency of 3 or more headache attacks per month during the past 3 months

2. Male or female, ages 18-65

3. Women are required to be postmenopausal, surgically incapable of bearing children, or
practicing a medically acceptable method of birth control (i.e., double barrier
method, IUD, Mirena, etc) for at least 1 month before study entry through 30 days
following last dose.

4. If postmenopausal and on hormone replacement therapy (HRT) then must to be on a stable
regimen for at least 2 months (continuous stable regimen of cyclic or non-cyclic HRT);
negative pregnancy test.

5. Native English speakers (due to speech and language analysis)

6. Montreal Cognitive Assessment (MoCA) score equal to or greater than 26.

Exclusion Criteria:

1. Onset of migraine occurred after age 50 years, or overuse of analgesics or migraine
specific agents for the acute treatment of migraine episodes; examples of analgesic
overuse included the following: more than 8 treatment episodes (episode defined as any
calendar day of usage) of ergot containing medications a month; more than 8 treatment
episodes of triptans a month; or more than 6 treatment episodes of potent opioids a
month.

2. Required, continued use of the following medications for any medical reason during the
study: beta-blockers, benzodiazepines, tricyclic antidepressants, antiepileptics,
calcium channel blockers, monoamine oxidase inhibitors, nonsteroidal anti-inflammatory
drugs (NSAIDs) daily, opioids, agents for insomnia (e.g., Ambien,
diphenhydramine-containing OTC products); corticosteroids, local anesthetics,
botulinum toxin within last three months, or herbal preparations such as feverfew or
St John's wort. However, subjects will be permitted to be on a stable regimen of a
selective serotonin reuptake inhibitor or SNRI for 3 months or more for depression
and/or anxiety.

3. A history of nephrolithiasis

4. Have previously taken topiramate

5. Received an experimental drug or used an experimental or approved device for migraine
prevention (e.g., TENIS unit) within 30 days of screening