Migraine Topamax


Migraine topamax..topamax migraine..do they fit together? Can you take it if you are pregnant?

Many of my patients come to me with questions about Topamax and headaches, which is one of the newer anti-seizure medications. (By new, I mean it is less than 20 years old..in medicine that's new!)They have heard about it from their friends or read about it elsewhere. So what's up with the migraine topamax connection?

Well, they are right! It does help with certain recurring headaches. Topamax affects headaches by reducing the number and severity of the pain. It can also slow the "take off phase" of a headache, allowing you to get some medication in you faster to stop the process.

Topamax is a preventative medication. You will be on low doses every day, but you need 90 days to see the full effect. Most people are on it for a few months, perhaps a year until control is reached.

See? I said control, not cure! Control means you get one or two mild headaches every month or so. One dose of a medication takes the headache away. When this occurs, then the migraine topamax combination has been effective. Topamax is most effective for migraines, but I have used it and have seen it be very effective with some cluster patients and some post-traumatic headaches.

Dosing for this medication is far lower than the dose for seizures. Ususally we can get good headache control with 100-600 mg whereas anti-seizure dosing is several thousand mg.

  • Topamax Side Effects

Now just about every drug has side effects but the art of medicine is balancing those against the benefit of treating the pain.

Topamax can cause weight loss in about 67% of people who take it. Woo-hoo! I can hear you cheering! But this can reverse itself after you stop the medication and it is not a reason by itself to prescribe it. Regulary exercise can make the weight loss occur quicker.

People who are diabetic or borderline diabetic seem to lose the weight faster as this drug affects insulin binding. It actually allows insulin to bind to cells and thereby drive blood sugar from the blood into the cell to be metabolized. Of note, I have had diabetics drop close to 100lbs on this drug so blood glucose must be monitored carefully while on it. If this happens to you, you must talk to your doctor about adjusting your diabetic medications to avoid hypoglycemic (low blood sugar) episodes.

Additional migraine topamax side effects include:

  • Numbness and tingling in the hands and feet, that wears off after a few months and is usually mild.
  • Word finding difficulty in about 15% of people. Again mild and reducing the dose for a week or two may help.
  • Blurry vision. You may have to discontinue the drug and this should resolve.
  • Kidney stones. This is rare, about 1% have this problem, and again with a history of this you should not take the drug.
  • Reasons to NOT take Topamax: glaucoma, anorexia, renal disease

Remember, when reading package inserts, side effects listed are all those that have EVER occurred in a patient. You will note that they are not graded in terms of severity so you cannot tell if the side effects were mild, moderate or severe. Only a health care provider who has experience with the medication will be able to tell you what they have seen clinically with their patients.

Many women are concerned about Topamax and pregnancy. Here is more about Topamax and pregnancy.

  • Topamax and Children's Headaches

The Journal of Headache Pain has released the findings of studies looking at the use of Topamax in children with headache. So there is a migraine topamax connection for kids. I should note that Topamax has been used for years in children with seizure disorders and has been found to be very safe.

Drs Ferraro and Tripani in Italy, reviewed five different studies in children and found "Topiramate has been proven to reduce headache frequency and the accompanying disability." This is good news and I can tell you we use Topamax for our teenagers in our headache clinic.

Side effects? Pretty much the same as what happens in the adult population, weight loss (NOT a drug for thin children or history of anorexia/bulemia), tingling in the fingers and toes, difficulty concentrating and abdominal pain.

These effects do not happen with every child, and if a problem the drug is easily withdrawn. Dosing here is even lower than for adults and children may respond quite well to only 25mg. For more information on child migraine and stomach migraines read here.

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