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Topamax For Migraines

by Cinni
(Maryland)

I am having trouble completely resolving my headaches. I had been diagnosed with Migraines and prescribed Topamax for daily treatment. However, I noticed very little results from this medication.

Instead, I resumed my over the counter treatment of Excedrine Migraine which had been much more effective and reliable. However, in the last week, I have been having continued sensations of headaches even after taking meds, symptoms not clearing up fully. What would you recommend to relieve this issue and improve results from treatment (i.e., completely resolving headache symptoms)?

Cinni

Answer:



Hi Cinni,

Topamax for migraines is an excellent medication for prevention of this type of headache. However, to break the cycle of daily headaches that are analgesic rebound headaches most of my patients respond to low dose steroid for one week, such as a medrol dose pak. You sound like a classic case of "headache due to medication overuse" which is the new term being used. The Excedrin fuels the headaches over time and episodic migraine moves slowing into chronic daily headache.

Don't stop the Topamax. It needs a full 90 days to have it's effect in the brain. If your doctor scheduled you for a follow up several months from now, call and move up the appointment to discuss what is going on. I usually taper topamax up to 100mg per day over 4 weeks, then let patients hang out at that dose for 2-3 months. What you are looking for is a reduction in the frequency and severity of the migraines, not an instant cure. The response is dose dependent so moving the dose up is a good idea if it seems to be working. Most of my patients are between 100mg and 600mg. Anti-seizure dosing for this medication is 3000mg so you can see that it is a low dose.

Most common side effect is weight loss (67%) but that too is dose dependent. Tingling in the extremities will go away after a few weeks.

What ever the doctor gave you to take at the onset of migraine should be used instead of Excedrine. I tell my patients that if the headache gets up to a 5/10 then take the medication.

Good luck!

Mary Kay Betz MS RPA-C

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Can I Take Topamax While Pregnant?

by Kelly
(New York)

I recently stopped taking my topamax. I was taking 200 mg. daily and gradually decreased by 50 mg. each week until I stopped completely. I did this because my husband and I are trying to have a baby and I kept getting conflicting answers from my neurologist and my OB/GYN as to whether it was safe to be on it and be pregnant.

I haven't noticed much of a difference with my headaches not being on topiramate but I have noticed some weight gain. I read on some blogs that people have experienced weight gain after being off of topiramate/topamax. I was wondering if you could tell me anything about this? I am very concerned and do not want to gain any more weight. I have put on about 8lbs. so far but I am small, only 4'10".

Also, what are your thoughts on staying on the drug and just stopping it when I know I am pregnant? Thanks for your help.

Kelly

Answer:

Hi Kelly,

Believe it or not, I get this type of question about once a week in my practice. "Can I take topamax while pregnant?" I have written well over 10,000 prescriptions for topamax over the years so I am pretty familiar with the medication.

Your neurologist is concerned with your headaches and from that point of view you have to consider your pain levels and frequency of headache. When you are in pain, your adrenaline levels are slightly elevated and if this is happening regularly it could impede implantation and make getting pregnant difficult. So the neurologist wants you to stay on it to prevent migraine.

Your OB/GYN however, is probably not as familiar with topamax and pregnancy and is more concerned by the fact that you might get pregnant on a medication that was recently labeled class D by the FDA. Class D drugs should not be taken in pregnancy and have shown to cause some birth defects.

Having said all this, I have had numerous patients who became pregnant while on the drug. As soon as they inform us, we taper them off the drug quickly. Dr. Mechtler, my supervising physician, is a board certified headache specialist and neurologist. He defers to the OB/GYN on this issue and if they do not want the patient on the topamax then we don't prescribe it.

Now, about the weight gain..topamax does cause weight loss. It does this two ways, by dampening the appetite centers in the brain and by facilitating the insulin/sugar balance in the body so sugar is burned more efficiently. This is why diabetics lose so much weight on the drug. It is possible that your appetite has gone up a bit and you did not even notice you are eating a bit more that you used to when on the drug. I have had some patients gain weight after stopping it, but it turns out they lost the weight to begin with when they started it.

Over all if planning pregnancy, I would advise you stay off the drug.

Good luck!
Mary Kay Betz MS RPA-C

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