Topiramate

More recently its efficacy in chronic daily has been shown.

I usually start at 25mg once daily for the first 2 weeks. I then increase to 25mg twice daily for another 2 weeks.

If there is still no improvement I increase by another 25mg to 50mg in the morning and 25mg at night for another 2 weeks.

Finally I go to 50mg twice daily. I usually like to persevere with the highest tolerated dose for a minimum of 8 weeks, preferably 12 weeks before deciding if the drug has been helpful in reducing migraine or any other headache.

A headache diary can help monitor the effect of treatment.

The most common reasons for treatment failure are not persevering for 8 to 12 weeks or intolerance due to side-effects.

Here's the list of potential uses related to severe headache disorders:

1. Migraine
2. Migraine aura
3. Chronic Migraine
4. Medication Overuse Headache
5. Cluster Headache
6. Idiopathic Intracranial Hypertension (Topamax has carbonic anhydrase properties)
7. Hypnic Headache

Side-effects

1. Numbness or tingling of the hands, feet, lips or mouth

About 90% of people with migraine will experiecne this on the drug

2. Abnormal taste sensation
3. Loss of appetite
4. Weight Loss

About 10% of people will lose about 10% of their body weight after several months of use of the drug.

5. Disturbed mood ot thoughts

Although relatively rare, depressive thoughts or ideas can occur with this drug, and it should be avoided, if possible, in people with a history of depression.

Some of my patients will describe a sense of futility or worthlessness, or just that they do not feel like themselves.

I recommend immediate cessation of topiramate if any symptoms of a psychological or psychiatric nature develop.

This makes it really important that this drug is only ever used under the supervision of your doctor.

6. Pregnancy is not advised when on topamax

At higher doses, the drug can interfere with metabolism of the oral contraceptive pill. Like any prescription medication you should always discuss these issues with your doctor.