Topamax for Migraine Prevention?

Topamax is a prescription medication that has been approved in the US for several different conditions. In addition to being used as an anticonvulsant, Topamax is also FDA-approved for use as a treatment in adults for migraine prevention. As of today, however, there have been no studies demonstrating its efficacy and/or safety in children and adolescents with migraines.

Topamax (topiramate) belongs to a group of medications known as carbonic anhydrase inhibitors. It works by reducing the amount of acid produced by cells in your body, which relieves symptoms such as frequent urination and excessive thirst caused by conditions like glaucoma and epilepsy (seizures). Topamax can be taken by itself, but it is usually prescribed in combination with other medications for epilepsy.

Topamax will not cure headaches or migraines, but it can decrease the number of attacks you have. It may also help to lessen the pain and nausea usually associated with them. The FDA approved Topamax for use as a treatment in adults for migraine prevention after studies showed that patients treated with this medication had fewer migraine attacks compared to those who were given a placebo (sugar pill).

The most common side effects related to Topamax are: 

diarrhea – double vision or blurred vision – loss of appetite – taste changes – tiredness/fatigue

More serious possible side effects include:

depression/mood problems thoughts of hurting yourself or others kidney stones/pain kidney failure life-threatening lung or breathing problems – liver problems metabolic acidosis, which is the build-up of too much acid in your blood lack of energy nausea, vomiting, loss of appetite, metallic taste in your mouth seizures. Decreased level of consciousness hiccups trouble sleeping.

pros and cons of Topamax for migraines:

Topiramate, marketed under the trade name Topamax among others, is a medication primarily used to treat epilepsy and migraine headaches. It is also used as an add-on treatment for depression.

Substantial weight loss may occur as a side effect of this drug. It has not been tested in pregnancy and should only be taken if the potential benefits outweigh any risks to the babAmong anticonvulsant drugs it appears to be among those with the highest risk of causing birth defects. Topiramate is thought to work by blocking AMPA, NMDA, and kainate receptors; inhibiting carbonic anhydrase, and modulating voltage-gated sodium channels.

Topiramate was initially approved for epilepsy in 1996 and was subsequently approved as a monotherapy and adjunctive treatment for migraine prevention in adults in 2002. It is now available as a generic drug. In the United States, it is also approved to prevent seizures following traumatic brain injury.

In Japan, Germany, Portugal, and Italy, topiramate is recommended by the Ministry of Health as a first-line preventive therapy against migraine attacks (>12/year). Topiramate has an FDA pregnancy category of X; this means that studies in pregnant women have demonstrated positive evidence of fetal abnormalities. The use of topiramate during breastfeeding is not recommended.

Topamax starting dose for migraines:

There are currently three evidence-based guidelines for migraine prevention. These are the US Headache Consortium guideline, the 2009 European Federation of Neurological Sciences/European Academy of Neurology (EFNS/EAN) guideline, and a joint headache society guideline from the UK. The EFNS/EAN guidelines recommend starting with topiramate 100 mg per day, increasing after one month to 200–400 mg daily in two or more divided doses.

This is based on randomized controlled trials showing topiramate to be effective at preventing migraines without any adverse effects on tolerability, although little difference was found between different dosages. The Cochrane review additionally addressed the efficacy of topiramate as an add-on to other preventive treatments in adults and children. In this population, topiramate had similar efficacy with no evidence of any adverse effects on tolerability.

The most common side effects, when used for migraine prevention, include paresthesias (tingling/numbness), fatigue, ataxia, speech problems ranging from slurring to dysarthria, an unsteady gait, memory loss, nausea and diarrhea, trouble concentrating, or depression.

Cognitive difficulties can be permanent. The US Headache Consortium guideline notes that the cognitive effects may be more frequent with rapid titration (>100 mg) or high dose (>200 mg). Additionally, there is a concern that topiramate may cause metabolic acidosis, leading to osteoporosis and kidney stones, although evidence suggests the incidence is no greater than in the general population. Due to its effects on the metabolism of vitamin D and phosphorus, regular blood tests for complete blood count, creatinine, and liver enzymes are recommended.

Topamax can be used as add-on therapy or alone depending on your preference. The studies seem to suggest that it’s just as effective when used either way. However, if you’re planning on getting pregnant anytime soon then it should only be taken if the potential benefits outweigh any risks to the baby. If you do get pregnant while at Topamax then don’t stop taking it without talking to your doctor first, as doing so can increase the chances of a miscarriage.

Topamax comes in 25mg tablets. Some doctors may recommend splitting the dose up into two doses per day, even though this doesn’t seem to be more effective than just one dose. The usual starting dose is one tablet of 25mg once or twice daily and you should increase it gradually by increasing the number of tablets rather than taking larger doses of 50 or 100mg.

If you find that you’re unable to tolerate more than four tablets per day then you need to lower your dosage and remember that side effects can take two weeks or longer to resolve on their own. Finally, Topiramate will affect how certain drugs work so to speak to your doctor or pharmacist before taking it with any other drugs.

Topiramate for migraines reviews:

The American Headache Society recommends starting with topiramate 100 mg daily, increasing after one month to 200–400 mg daily in two or more divided doses. The EFNS guidelines recommend starting with 100 mg/day, increasing after one month to 200–400 mg/day (in 2 or more divided doses).

Treatment of acute migraine has been shown to benefit from a dosage of 100–200 mg/day. This dose may be higher for patients who require additional coverage for the prevention of migraine, but tolerance should always be individualized and medication should never be increased without medical supervision.

Topiramate is also used as an adjunctive treatment for epilepsy and has been shown to benefit patients even at low doses. A daily dose of 25 mg/day is beneficial in reducing seizure frequency, with minimal side effects.

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Topamax is indicated for adjunctive therapy in the treatment of partial-onset seizures, primary generalized tonic-clonic seizures, and migraine prophylaxis. The usefulness of topiramate as initial monotherapy at recommended doses has not been established. Topiramate is an anticonvulsant.

The precise mechanism(s) by which topiramate exerts its antiseizure and migraine prophylactic activity are unknown. Topiramate has demonstrated electrophysiologic properties consistent with a site of action in the neocortex, including reversible effects on voltage-gated Na+ channels, delayed excitatory junction potentials, reduced functional coupling between glutamate decarboxylase and neuronal nitric oxide synthase, inhibition of the persistent sodium current, enhancement of the slow inactivation of the sustained sodium current, and antagonism of high-threshold calcium currents.


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