Migraine is more than a headache. It often lasts longer (up to 72 hours) and is more severe.
There are many symptoms of migraine, including nausea, vomiting, and sensitivity to light and sound. The major symptom is moderate to severe pain that typically occurs on one side of your head.
Some migraine types present with symptoms that affect the senses, including and especially sight, called migraine with aura.
Aura is a term that refers to symptoms preceding a migraine attack. Migraine with and without aura have different diagnostic criteria and treatment approaches.
Certain drugs are available to help prevent migraine attacks. Migraine prevention drugs are different from drugs that treat migraine attacks that have already started.
You take migraine prevention drugs on a scheduled basis. They help reduce the number of migraine attacks that you have and also help make them less severe.
One of these drugs for migraine prevention (with or without aura) is called Topamax (topiramate).
Topamax belongs to a class of drugs called anticonvulsants. A class of drugs is a group of drugs that work in a similar way.
Although anticonvulsants are used to treat epilepsy, many anticonvulsants are also effective for other conditions, including migraine.
The exact way that Topamax works to help prevent migraine attacks isn’t known. It’s believed that Topamax calms overactive nerve cells in the brain that lead to migraine attacks.
Topamax is taken orally. Topamax is the brand name for the generic drug topiramate.
The medication is available in immediate and extended release formulations and in both a brand medication and generic medication. Generic drugs usually cost less and are typically preferred by insurance.
Dosage is currently available in the following forms:
| Topomax | Generic topiramate |
| Oral capsule: 15 mg and 25 mg | Oral capsule: 15 mg and 25 mg |
| Oral tablet: 25 mg, 50 mg, 100 mg, 200 mg | Oral tablet: 25 mg, 50 mg, 100 mg, 200 mg |
To help prevent migraine, up to 100 mg of Topamax be taken daily by people over the age of 12, administered in two doses.
The recommended starting dosage is 25 mg of Topamax taken once each evening.
After 1 week, the dosage may be increased to 25 mg twice daily. After 2 weeks, 25 mg in the morning and 50 mg in the evening is recommended.
After 3 weeks, the recommended dosage is 50 mg in the morning and 50 mg in the evening. Your dose and titration will be guided by clinical response and tolerability.
The following are the average retail costs of a 1-month supply (60 tablets or capsules) of Topamax. Be aware that these prices change often, differ by location, and don’t include discounts that your insurance company may provide.
| STARTING DOSAGE | FORM | MONTHLY COST |
| 25 mg twice daily | Brand-name tablet | $465 |
| 25 mg twice daily | Brand-name capsule | $568 |
| 25 mg twice daily | Generic tablet | $71 |
| 25 mg twice daily | Generic capsule | $146 |
| 50 mg twice daily | Brand-name tablet | $749 |
| 50 mg twice daily | Generic tablet | $116 |
You’ll likely not notice Topamax working right away when you first start using it.
It may take 1 month for your migraine attacks to become less frequent and 2 to 3 months for Topamax to become fully effective.
Keep your doctor updated on your symptoms while taking Topamax.
As with any drug, Topamax can cause side effects. The lists below highlight the more common and the more severe side effects that are possible when taking this drug.
The more common side effects of Topamax can include:
- memory and cognition issues, such as difficulty concentrating and language issues
- tingling in your arms and legs
- decreased appetite
- weight loss
- changes in how things taste
- kidney stones
- nausea, stomach pain, and diarrhea
- fatigue
- trouble sleeping
- dizziness
- nose and throat (upper airway) infections
Serious side effects of Topamax can include:
- eye problems, including vision loss
- decreased sweating that can lead to increased body temperature (may feel like a fever that doesn’t go away)
- suicidal thoughts. If you’re having any thoughts of suicide, help is available.
Several randomized, controlled trials have shown that Topamax reduces the frequency, intensity, and duration of migraine attacks in adults.
Topamax has been found to be a cost-effective treatment that helps improve the quality of life for people who live with migraine.
Migraine can affect your quality of life. This is especially true if the attacks are severe and frequent.
Migraine is also underreported, underdiagnosed, a
Reducing the number or severity of migraine attacks you have is the best way to minimize the effect they have on your day-to-day life. Topamax is one drug that may help, especially if other therapies haven’t worked.
Talk with your doctor about Topamax. Your doctor knows your medical history and will choose the type of therapy that is most likely to work for you.
If you’re pregnant, talk with your doctor about additional risks of taking Topamax during pregnancy.
Keeping track of your migraine episodes with a migraine diary will aid your doctor in understanding your condition and determine your treatment effectiveness.