{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:35:15Z","timestamp":1788240915600,"version":"build-2803163510"},"reference-count":18,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Cephalalgia"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Candesartan and topiramate are both recommended for migraine prevention, but direct comparative data remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate and compare the tolerability and effectiveness of candesartan versus topiramate for migraine prevention using systematically collected real-world data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This longitudinal cohort study included patients treated at the Leiden Headache Center (LHC), with data collected using our validated E-headache diary. The 28 days preceding treatment initiation served as the baseline period. The primary endpoint was the proportion of participants that discontinued candesartan or topiramate within the 6-month follow-up. Secondary endpoints included \u226550%-response rate, change in monthly migraine days (MMD), headache days (MHD), acute medication days (MAMD), and HIT-6 from baseline to the last 28-day period with the highest achieved dosage of candesartan (ranging 4\u201332\u2005mg daily) or topiramate (25\u2013100\u2005mg daily). Patients were assigned a propensity score based on baseline MHD, MMD, HADS, and number of failed preventive treatments. The primary analysis looked at discontinuation rates of candesartan and topiramate by using a Kaplan-Meier curve with Cox regression, adjusting for group differences by including the propensity score as a covariate. Secondary endpoint regressions were adjusted for propensity score and time to reach the highest dosage month. The primary and secondary outcomes were also investigated in a sensitivity analysis by applying optimal matching based on the propensity score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total 661 migraine participants were included. In the candesartan group less participants discontinued medication within 6-months follow-up compared to the topiramate group (29.7% versus 67.3%; HR 2.5 [95% CI: 1.9\u20133.3], p\u2009&lt;\u20090.001). Candesartan had higher \u226550% response rates than topiramate (47% versus 29%, OR 0.6 [95% CI: 0.4\u20130.8], p\u2009=\u20090.004) and greater reduction in MHD (difference \u22121.1 days [95% CI: \u22122.2 to \u22120.01], p\u2009=\u20090.04). No differences were observed between treatments in reduction of MMD, MAMD, or HIT-6 scores after adjustment. These findings were confirmed in the sensitivity analysis using optimal matching.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Candesartan demonstrates a favorable tolerability and effectiveness profile compared to topiramate. Therefore, (inter)national treatment guidelines for migraine prevention should be revised to spare patients from being prescribed medications that have a low tolerability profile, as demonstrated by this study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03331024261426952","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T14:49:25Z","timestamp":1773240565000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Superior outcomes of candesartan over topiramate in the treatment of migraine: A comparative cohort study"],"prefix":"10.1177","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1047-9026","authenticated-orcid":false,"given":"Annemijn S.J.C.","family":"Oosterlee","sequence":"first","affiliation":[{"name":"Leiden University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8999-0087","authenticated-orcid":false,"given":"Britt W.H.","family":"van der Arend","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3558-8065","authenticated-orcid":false,"given":"Nancy","family":"van Veelen","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7261-762X","authenticated-orcid":false,"given":"Irene","family":"de Boer","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anique","family":"de Groot","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benthe","family":"Geuns","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"van Zwet","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1763-5443","authenticated-orcid":false,"given":"Nadine","family":"Pelzer","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3140-6882","authenticated-orcid":false,"given":"Gisela M.","family":"Terwindt","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-021-00509-5"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/03331024211053571"},{"key":"e_1_3_4_4_2","first-page":"943","article-title":"Topiramate in migraine prophylaxis\u2013results from a placebo-controlled trial with propranolol as an active control","volume":"251","author":"Diener HC","unstructured":"Diener HC, Tfelt-Hansen P, Dahl\u00f6f C, et al. Topiramate in migraine prophylaxis\u2013results from a placebo-controlled trial with propranolol as an active control. J Neurol 2004 Aug; 251: 943\u2013950.","journal-title":"J Neurol"},{"key":"e_1_3_4_5_2","first-page":"17","article-title":"Topiramate in the prevention and treatment of migraine: efficacy, safety and patient preference","volume":"6","author":"Naegel S","unstructured":"Naegel S, Obermann M. Topiramate in the prevention and treatment of migraine: efficacy, safety and patient preference. Neuropsychiatr Dis Treat 2010 Feb 3; 6: 17\u201328.","journal-title":"Neuropsychiatr Dis Treat"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(25)00269-8"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.1.65"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/0333102413515348"},{"key":"e_1_3_4_9_2","first-page":"333102424124883","article-title":"Candespartan study: candesartan Spanish response-prediction and tolerability study in migraine","volume":"44","author":"Garc\u00eda-Azor\u00edn D","unstructured":"Garc\u00eda-Azor\u00edn D, Mart\u00ednez-Badillo C, Cami\u00f1a Mu\u00f1iz J, et al. Candespartan study: candesartan Spanish response-prediction and tolerability study in migraine. Cephalalgia 2024 Apr; 44: 3331024241248833.","journal-title":"Cephalalgia"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-020-09989-9"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-83508-2"},{"key":"e_1_3_4_12_2","first-page":"333102425131801","article-title":"Guidelines of the International Headache Society for Real-World Evidence studies in migraine and cluster headache","volume":"45","author":"Pozo-Rosich P","unstructured":"Pozo-Rosich P, van Veelen N, Caronna E, et al. Guidelines of the International Headache Society for Real-World Evidence studies in migraine and cluster headache. Cephalalgia 2025 Mar; 45: 3331024251318016.","journal-title":"Cephalalgia"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/03331024211010306"},{"key":"e_1_3_4_14_2","first-page":"333102423116662","article-title":"Defining migraine days, based on longitudinal E-diary data","volume":"43","author":"van der Arend BWH","unstructured":"van der Arend BWH, Verhagen IE, van Leeuwen M, et al. Defining migraine days, based on longitudinal E-diary data. Cephalalgia 2023 May; 43: 3331024231166625.","journal-title":"Cephalalgia"},{"key":"e_1_3_4_15_2","unstructured":"Patient Journey App. https:\/\/patientjourneyapp.com\/ (2025 accessed May 2025)."},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/0333102417738202"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/0333102410379890"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1080\/00273171.2011.568786"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2006.00506.x"}],"container-title":["Cephalalgia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03331024261426952","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/03331024261426952","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03331024261426952","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T10:15:25Z","timestamp":1779185725000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/03331024261426952"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":18,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1177\/03331024261426952"],"URL":"https:\/\/doi.org\/10.1177\/03331024261426952","relation":{},"ISSN":["0333-1024","1468-2982"],"issn-type":[{"value":"0333-1024","type":"print"},{"value":"1468-2982","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"article-number":"03331024261426952"}}