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Topiramate Weight Loss In Migraine Patients

Topiramate Weight Loss In Migraine Patients


Topiramate (TPM) is generally recognized efficacious and safe in migraine prevention. A significant proportion of patients undergoing TPM administration may show weight loss. In epileptic subjects, high body mass index (BMI) was found to be predictive of weight loss under TPM therapy. We therefore aimed to study whether common clinical determinants may be associated to TPM weigh loss in migraine patients. In our clinical series, high BMI was not found a predictor of weight loss under TPM treatment. Unknown genetic and environmental factors that may determine the courses of weight loss under TPM therapy are still do be identified.


The short answer is “we’re not sure actually”.

Topiramate was originally developed for epilepsy. [ii] Those with epilepsy started noticing an improvement in their migraine condition in several case studies and from there a trial was conducted to test migraine patients specifically. It was not designed with migraine in mind but it is arguably an effective treatment for the prevention of migraine.

Epilepsy and migraine share a number of biological and clinical features in common. [ii] Perhaps not surprising to find that anticonvulsant medications may have a therapeutic benefit for both indications.


The short answer – it’s considered to be an effective option for migraine prevention.

Both US and European authorities have given Topamax or topiramate what they term ‘Grade A’. Grade A is the highest rating a treatment can receive. The grade is a reflection of the quality of research evidence and the efficacy of its results according to the clinical evidence.

When several clinical research studies are collectively reviewed to analyze and evaluate research it is called a systematic review. Often meta-analysis is used to summarise the results of these studies.


Topiramate like many other medications interacts with other medicines and can have dangerous consequences. It is important to ensure your doctor has a full list of everything you are currently taking.

  • Interactions of Topamax (topiramate) include:
  • Other antiepileptic drugs
  • Central Nervous System Depressants
  • Oral contraceptives
  • Lithium
  • Carbonic Anhydrase Inhibitors (eg. zonisamide or acetazolamide)
  • Hydrochlorothiazide (HCTZ)
  • Pioglitazone
  • Amitriptyline


Ranges from 25 mg to 200 mg per day.

  • Topiramate is one of those treatments where it is very appropriate to ‘Go Slow, Start Low’. It is often initiated at a dose of 25 mg per day with a gradual increase to your maximum tolerated dose.
  • Your maximum tolerated dose is basically how much you can take without the side effects or adverse events becoming worse than any benefit derived from the treatment.
  • In clinical trials a maximum dose of 200mg has been researched frequently. Interestingly, in epilepsy, studies have researched dosages up to 400mg.


From the user reviews, 48% of patients report (n = 1236) severe or moderate side effects with topiramate. The most common side effect being weight loss (n = 94) followed by brain fog (n = 66), memory problems (n = 56) hands tingling (n = 54) and word fishing (n= 52).


There is a general agreement amongst users that at least 30% experience a moderate improvement with a further 11% to 35% experiencing major improvement depending on the source.This could be considered similar to the systematic review of clinical research where twice as many patients report a 50% headache frequency reduction versus placebo.Side effects from topiramate are common. Some might consider weight loss a welcomed side effect. Other side effects like tingling or word fishing might not be considered severe but some people may not tolerate memory problems or brain fog. Everyone is unique in the side effects they experience. Some may not experience any, whilst others may find them intolerable.

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