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Topiramate For Headaches

Topiramate For Headaches

What is topiramate for headaches, and how does it work (mechanism of action)?

Topiramate is an oral drug that is used to prevent the seizures of epilepsy. It is an anti-epileptic or anti-seizure drug. It is used primarily among patients who are not controlled by other anti-epileptic drugs. About 1 in 4 Americans diagnosed with epilepsy has seizures that resist treatment with other anti-epileptic drugs. Topiramate also prevents migraine headaches.Seizures are due to the abnormal activity ("firing") of nerves in the brain, and the abnormal activity spreads to smaller or larger portions of the brain. Although topiramate's exact mechanism of action is unknown, scientific studies suggest that it may alter neurotransmitters within the brain. Neurotransmitters are chemicals that nerves manufacture and

take topiramate

Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about topiramate and will provide you with a full list of the side-effects which you may experience from taking it.Take topiramate exactly as your doctor tells you to. It is usual to start topiramate treatment on a low dose (25 mg at night), and then for the dose to be increased gradually. A usual maintenance dose is 50-100 mg daily, taken either as a single dose or divided into two doses over the day.Swallow topiramate tablets with a drink of water. Do not chew the tablets as they have a bitter taste. If you have been prescribed capsules, you can swallow the capsules in the normal way with a drink of water or, if you prefer, you can open up the capsule and sprinkle the contents on to a spoonful of some soft food (porridge, yoghurt or custard for example). Do not chew the contents of the capsules.


Topiramate has been studied in patients age 12 to 65 years who had an average of 5.5 headaches per month at baseline. At a dosage of 50 mg twice per day, topiramate reduced migraine frequency by approximately two headaches per month compared with a reduction of one headache per month with placebo.2–4 At the same dosage, between 37 and 54 percent of patients had at least a 50 percent reduction in monthly headache frequency compared with a 22 percent response rate for patients receiving placebo (number needed to treat = 3 to 7).2–4 The reduction in migraine frequency generally was observed after one month of treatment. A Cochrane review5 of anticonvulsants for migraine prevention, which included topiramate, showed that anticonvulsants as a class reduced migraine frequency by 1.4 attacks per month, similar to the effect seen for topiramate. Topiramate has not been directly compared with other anti-epileptic drugs, tricyclic antidepressants, or calcium channel blockers. However, one study4 included propranolol (Inderal) as an active control. Topiramate and propranolol had similar efficacy, decreasing migraine frequency by 1.6 headaches per month.

Topiramate (Topamax) for Migraine Prevention

Topiramate (Topamax) is an antiepileptic drug recently approved by the U.S. Food and Drug Administration (FDA) for prevention of migraine headache in adults. Its exact mechanism of action is uncertain, but it is known to affect neuronal hyperexcitability,1 which is one probable factor in the development of migraine.

Is topiramate safe to take if I'm pregnant or breastfeeding?

Topiramate has been associated with cleft palate in newborns whose mothers used topiramate during the first trimester of pregnancy.

Topiramate is excreted in human milk at levels 10% to 20% the levels in the mother's blood.

side effects

Many clinical trials evaluated the safety and efficacy of Topiramate. The most common side effects experienced by those taking Topiramate include:

  • Decreased sweating
  • Fever and flushing
  • Vision problems
  • Metabolic acidosis (increased level of acid in your blood)
  • Numbness or tingling in the fingers and toes (paresthesia)
  • Anorexia
  • Weight loss
  • Diarrhea
  • Nausea
  • Feeling weak, drowsy, or tired
  • Upper respiratory infections
  • Speech and memory difficulties


Keep track of when you have migraine attacks and when you take Topiramate so you can monitor its effectiveness, and communicate with your doctor about how the medication is working for you.Before taking Topiramate make sure to tell your doctor about all the medicines you take, including prescription and nonprescription, vitamins, and herbal supplements. Topiramate and other medicines may impact each other, causing side effects.Because Topiramate can cause dizziness, weakness, and drowsiness, do not drive a car, use machinery, or do anything requiring you to be fully alert when taking this medication.


Migraine and epilepsy share many biologic features, and so not surprisingly certain of the newer antiepileptic drugs have proven to be effective for the prevention of migraine attacks as well as seizures. One of these drugs is topiramate (Topamax), and its successful performance in carefully conducted national studies has led to topiramate receiving the Federal Drug Administration indication for use in migraine prevention.Precisely how topiramate prevents migraine is unclear, but, generally speaking, it appears to reduce the genetically derived brain hyperexcitability that provokes migraine attacks in susceptible individuals.As a potent, “brain-active” medication, topiramate is not without potential side effects. Early in therapy topiramate may cause nausea or other gastrointestinal distresses. It also commonly produces an odd “pins and needles” sensation that may involve the hands, feet, or even the face; this side effect is benign, causes no neurologic injury, and is usually transient. More concerning is the drug’s potential for causing cognitive disturbance, typically manifested by impairment of recent memory, impaired concentration, or word finding difficulties

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