Topiramate For Migraine: Dosage And Side Effects

Using Topiramate For Migraine 

Considerable advances have been made within the last couple of years regarding preventive treatments for migraine, and one such drug, topiramate (Topamax), has successfully been proven to be effective within clinical trials in reducing migraine frequencies.  

While topiramate is used to treat epilepsy, topiramate received approval from the Food and Drug Administration (FDA) to treat migraine. This is interesting as migraine and epilepsy share similar pathophysiological mechanisms, which explains why topiramate can treat migraine attacks effectively. 

How Does Topiramate Treat Migraine Attacks?

Though the exact explanation of how topiramate works for migraine remains to be unclear, experts believe that topiramate treats migraine attacks by reducing abnormal brain excitability. Topiramate targets the electrical activity in the brain by decreasing electrical activity, which allows it to prevent the initiation of both episodic conditions as neuronal hyperexcitability is believed to be the “initiator” for seizures and migraine. Within the context of migraine specifically, it is believed that neuron hyperexcitability leads to the event of CSD (Cortical Spreading Depression). 

Cortical Spreading Depression And Migraine

What exactly is CSD? CSD/Cortical Spreading Depression refers to the event of cellular depolarization that is believed to cause migraine aura and headache pain. With the prevention of hyperexcitability, it is hypothesized that the event of CSD is also prevented, hence making Topiramate an ideal treatment for those suffering from chronic migraine. 

As a “brain-active” medication, the usage of topiramate has to be carefully regulated; it is recommended to start with a low dosage and then gradually increase the dosage in order to mitigate the extent of side effects.

Topiramate Dosage For Migraine

Within clinical trials, 50 milligrams being administered twice daily (100 mg per day) was proven to be the most effective topiramate dosage for migraine within the overall population. However, your healthcare provider may recommend a different dosage as a higher or lower dose may be more appropriate for an individual patient — topiramate dosage plans for migraine may also differ, with some plans starting out with a lower dosage and gradually building up to a higher dosage.

Side Effects Of Topiramate For Migraine

As with any other medication, using topiramate for migraine has its share of side effects. One such side effect is that Topiramate can cause nausea and other gastrointestinal diseases. Another side effect of topiramate for migraine is the tingly “pins and needles” sensation within the face, hands, and feet– but this side effect from the medication itself does not cause neurological injury. Additionally, during the first couple of months of therapy (1-2 months), the drug can cause impaired vision due to increased intraocular pressure. 

Other side effects of topiramate for migraine include impact on cognitive function such as:

• Impaired concentration
• Impaired memory 
• Word finding difficulties

Though these cognitive side effects do seem like a handful, it is important to note that the risk for developing these side effects decreases when using the method of building up to a certain dosage (starting with a lower dosage, and then gradually increasing it). However, even with the method of gradually increasing the dosage, there still remains a risk of developing these side effects. 

Topiramate Uses For Weight Loss

Topiramate has also been known to cause weight loss– in fact, it was originally used as an anticonvulsant. Phentermine and topiramate extended-release capsules are both medications that are used as a weight loss medication with topiramate specifically acting as an anticonvulsant– this means that Topiramate works by decreasing appetite and causing the feeling of fullness to last longer. These same effects apply when a patient uses Topiramate for either migraine or seizures, therefore, usage of this medication over a prolonged period of time can lead to weight loss. 

Topiramate For Migraine Reviews

According to a study conducted by the Jefferson Headache Center where data was collected from 49 US clinical centers, topiramate for migraine reviews showed that significantly more topiramate-treated patients experienced a 50% or more reduction in monthly headache frequency compared to the placebo group. International guidelines also mention topiramate as a first-line medication for the prevention of migraine. 

However, when it comes to being compared to the efficacy of other migraine drugs, topiramate has its disadvantages. An analysis published by the Journal of Headache and Pain compared topiramate with Erenumab (a CGRP inhibitor migraine medication), and the results illustrate that there was a favorable tolerability of Erenumab over topiramate as patients were more likely to discontinue topiramate due to its adverse effects. Furthermore, when it came to efficacy, patients taking Erenumab also had a higher reduction in MMD (monthly migraine days).

Alternatives To Topiramate For Migraine

There are other alternatives to topiramate for migraine treatment. Some alternative includes metoprolol, valproate, frovatriptan propranolol, and timolol.

References

1. Topiramate (Topamax) for Migraine Prevention | AMF. American Migraine Foundation. Published July 11, 2006. https://americanmigrainefoundation.org/resource-library/topiramate-topamax-migraine-prevention/
2. Naegel S, Obermann M. Topiramate in the prevention and treatment of migraine: efficacy, safety and patient preference. Neuropsychiatric Disease and Treatment. 2010;6:17-28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951059/
3. Phentermine and Topiramate: MedlinePlus Drug Information. Medlineplus.gov. Published 2017. https://medlineplus.gov/druginfo/meds/a612037.html
4. Ehrlich M, Hentschke C, Sieder C, Maier-Peuschel M, Reuter U. Erenumab versus topiramate: post hoc efficacy analysis from the HER-MES study. The Journal of Headache and Pain. 2022;23(1). doi:https://doi.org/10.1186/s10194-022-01511-y

(The above article is contributed by Shreesha Halder, one of our amazing volunteers).