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Topiramate Migraine

Topiramate Migraine

Topiramate (Topamax) for Migraine Prevention

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; while these cognitive side effects occur in a minority of patients and may be minimized by beginning with a low dose and gradually increasing the dosage each week, the “start low/go slow” technique does not totally eliminate the risk. In rare instances, during the first 1 to 2 months of therapy the drug may cause impaired vision by increasing intraocular pressure (“glaucoma”). Topiramate not uncommonly causes weight loss, and the degree of weight reduction tends to correlate with dose and duration of therapy. Finally, the drug may cause carbonated beverages to taste “flat.”Patients were aged 12 to 65 years, had a 6-month International Headache Society migraine history, and experienced 3 to 12 migraines per month, but had 15 or fewer headache days per month during the 28-day baseline period.

Who Gets Migraine?

Migraine is one of the most common health conditions worldwide.Migraine affects around 1 billion people globally. Of those with migraine, just over half (54%) claim to experience one or more attacks per month. 13% claim one or more attacks per week.If you do the math, that’s around 130 million people who get weekly migraine.Migraines typically affect more women than men. Ratio’s vary depending on how broad or where the study is. Some claim that women are 2x as likely, others claim women are 3x more likely than men to experience migraine.The reality is likely somewhere in between i.e. women are 2-3 times more likely to get migraine versus men.Children can have migraine as well. They can start at any age but are most common in their early to mid-teens.

Why Do I Get Migraine Attacks?

Why do I get migraine attacks and not my sister for example? Interestingly, no one has figured out exactly Recently medical researchers have discovered a genetic link between migraine. This means that if your parents or grandparents had migraine then you are at risk of inheriting the susceptibility of migraine.If a mother experiences migraine, the child has a 50% chance of inheriting migraine. If both parents experience migraine, the child’s risk jumps to 75%.Environmental factors also play a role. Several head injuries such as concussion, whiplash or trauma may set off migraine attacks. A lifetime of inadequate sleep, poor diet, lack of exercise, high stress may also play role. Physical abuse or difficult childhoods may also be linked with migraine incidence.

What Happens During A Migraine?

Researchers still don’t know exactly what causes a migraine attack, which makes a cure that much more difficult to develop. The leading theories for the cause of migraine relate to hyper excitability within certain areas of the brain or a ‘glitch’ from the brain stem which triggers the migraine.The brain stem is a small but extremely important part of the brain. It allows the nerve connections of the motor and sensory system to pass from the brain to the body. It covers all of our sensations and the ability to move our body.At the start of an attack, chemical changes are thought to originate in the brainstem which starts a series of reactions causing the brain to react and cascade into a migraine attack.

What Causes A Migraine Attack?

For someone who has a physiological tendency towards migraine there are a number of potential causes that can ‘set off’ a migraine attack. Unfortunately, these are different for everyone. And even in the same person, triggers can be different at different times.Common migraine triggers such as stress, sleep, alcohol and hydration are used in this example. A migraine patient may go out on the weekend, have a late night out on Saturday night, not get much sleep and drink a little too much. The next day they experience a migraine.However the same patient may experience a migraine during the week at work when they didn’t drink or go out late. Instead they had a very stressful day and forgot to drink enough fluids. This may be enough to trigger another migraine.Because they are many different scenarios and many different triggers it can be difficult for patients to effectively control their migraine condition.

Some common migraine triggers include:

  • sleep disruption or changing sleep/wake cycle
  • stress
  • dehydration
  • menstruation in women
  • visual factors such as bright or flickering lights, screens or fluorescent lights

Understanding what migraine is and learning more about how and why they occur will help control them. Sometimes simply realizing you have migraine is a challenge in itself.Once you have been diagnosed with migraine, there are a number of helpful videos that take us deep into the brain to describe the hypothesized pathophysiology or mechanics of migraine.

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