Topamax (Topiramate) for Migraine

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Topamax (topiramate) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) for the preventive treatment of migraine in people 12 years of age and older.

What Members Say

MHT logo These insights are based on 1,177 comments about Topamax from MyMigraineTeam members. These are the experiences of a small number of individuals and are not meant to be medical advice.

Benefits:

Migraine frequency often drops, sometimes from daily attacks to only a few monthly.
Preventive relief can feel meaningful enough to improve work, travel, and daily routines.
Taking it daily at home can fit into a simple prevention routine.

Considerations:

Brain fog, word-finding trouble, and memory problems are common and can affect work.
Paresthesia (tingling in the hands, feet, or face) is common and can be hard to tolerate.
Kidney stones are a serious recurring concern, and hydration is recommended.

How Topamax Works and How It’s Taken

Topamax is a type of medication called an anti-seizure medicine. The exact way it helps prevent migraine attacks is not fully known.

Studies show that Topamax affects several processes in the body. It blocks certain sodium channels, increases the activity of gamma-aminobutyric acid (GABA), lowers activity at some glutamate receptors, and inhibits carbonic anhydrase enzymes.

Doctors prescribe Topamax when people 12 years of age and older need preventive treatment for migraine. By affecting these processes, Topamax may help reduce migraine frequency.

Topamax is given by mouth as a tablet or sprinkle capsule. It is usually taken in two divided doses each day. Treatment is started at a low dose and increases gradually over several weeks.

Topamax tablets should not be broken because they have a bitter taste.

Topamax sprinkle capsules may be swallowed whole. They may also be opened and sprinkled on 1 teaspoon of soft food. Swallow the food and medicine mixture right away.

Drink fluids right after to make sure all of the mixture is swallowed. Do not chew the mixture. Do not store it for later use.

Typical Dosing for Migraine

The recommended total daily dose of Topamax for the preventive treatment of migraine in people 12 years of age and older is 100 milligrams a day taken in two divided doses.

The recommended titration schedule is:

Week 1 — 25 milligrams in the evening
Week 2 — 25 milligrams in the morning and 25 milligrams in the evening
Week 3 — 25 milligrams in the morning and 50 milligrams in the evening
Week 4 — 50 milligrams in the morning and 50 milligrams in the evening

Dose and titration rate should be guided by clinical outcome. Longer intervals between dose adjustments may be used.

This information is based on the prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Top Advice From Members on Topamax

These insights are based on 1,177 comments about Topamax from MyMigraineTeam members.

Members who use Topamax often say the biggest practical lessons are to watch closely for side effects, stay in touch with your doctor if they affect daily life, and give the medication some time if side effects are mild and improving. Many members also say it helps to stay consistent with dosing, keep track of migraine patterns and reactions, and ask about tapering or dose changes rather than making changes on your own.

1

Watch for brain fog, memory changes, and word-finding problems.
“I had definite brain fog and trouble finding words during important meetings, but the side effects improved over time.”
2

Tell your doctor if side effects affect driving, work, or daily activities.
“Doctor is reducing the Topamax to 50 milligrams. I am hoping the side effects are not so bad. With 100 milligrams I could not do my job. I found a medicine that works, but the side effects are too extreme.”
3

Drink plenty of water and mention any kidney concerns.
“Topamax worked well for me for several years until I developed kidney stones. Make sure you drink extra water.”

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Topamax Side Effects

In clinical studies of Topamax for the preventive treatment of migraine in people ages 12 and older, the most common side effects occurred in about 5 percent to 51 percent of people. These include:

Paresthesia (tingling in the arms or legs)
Anorexia (loss of appetite)
Weight loss
Taste perversion (change in the way foods taste)
Diarrhea
Nausea
Trouble with memory
Hypoesthesia (decreased feeling or sensitivity in the skin)
Upper respiratory tract infection, such as a cold
Abdominal pain

Serious Side Effects and Warnings

Topamax can cause serious side effects that may require immediate medical attention. These include:

Acute myopia and secondary angle-closure glaucoma — Serious eye problems, including sudden vision changes or eye pain, can lead to permanent vision loss.
Visual field defects — Changes in side vision can happen with or without high eye pressure.
Oligohidrosis and hyperthermia — Decreased sweating and increased body temperature can lead to overheating, especially in hot weather.
Metabolic acidosis — Too much acid in the blood can affect bones, kidneys, growth in children and teens, and pregnancy.
Suicidal thoughts or behavior — New or worsening depression, mood changes, or thoughts of self-harm can occur.
Cognitive and neuropsychiatric adverse reactions — Mental health side effects can include confusion, slowed thinking, trouble concentrating, speech or language problems, somnolence (sleepiness), fatigue, depression, or mood problems.
Fetal toxicity during pregnancy — Topamax may increase the risk of birth defects, such as cleft lip or cleft palate, and babies being small for gestational age.
Decrease in bone mineral density — Lower bone mineral density (BMD) can occur.
Negative effects on growth — Decreased height and weight growth can occur in children.
Severe allergic reactions — Anaphylaxis or angioedema can cause swelling of the face, lips, tongue, or throat, and trouble breathing.
Drug reaction with eosinophilia and systemic symptoms (DRESS) or multiorgan hypersensitivity — This severe drug reaction may include fever, rash, swollen lymph nodes, facial swelling, and organ problems.
Serious skin reactions — These can include Stevens-Johnson syndrome and toxic epidermal necrolysis, which can cause severe rash with blistering or peeling skin.
Hyperammonemia and encephalopathy — High ammonia levels and brain dysfunction can cause unusual sleepiness, vomiting, or changes in thinking.
Kidney stones — Hard deposits in the kidneys can cause pain or blood in the urine.
Hypothermia when used with valproic acid — Dangerously low body temperature can affect thinking.

Get medical help right away if you think you are having a serious reaction.

How To Save on Topamax

The Topamax website offers the Topamax Savings Program. Eligible people with commercial or private insurance may pay $4 per fill, up to a $150 limit for each 30-day supply.

The Topamax Savings Program also offers a savings card you can download, print, and use at a participating retail pharmacy. The offer is not valid for people using Medicare, Medicaid, or other government-funded programs to pay for their medications. To learn more, visit the Topamax Savings Program.

What To Know Before Taking Topamax

Before starting Topamax, your doctor may order blood tests, including serum bicarbonate levels, because Topamax can cause metabolic acidosis, which means too much acid in the blood.

Before taking Topamax, tell your doctor about all of your medical conditions, including if you have:

Depression, mood problems, or suicidal thoughts or behavior
Kidney problems, kidney stones, or receive kidney dialysis
A history of metabolic acidosis
Liver problems
Weak or soft bones, including osteomalacia, osteopenia, osteoporosis, or low bone density
Lung or breathing problems
Eye problems, especially glaucoma
Diarrhea
Growth problems
A ketogenic diet, which is high in fat and low in carbohydrates
Plans to have surgery

Tell your doctor if you have any allergies to topiramate or any ingredients in Topamax. Do not take Topamax if you have had a serious allergic reaction to topiramate or any of its ingredients.

Tell your doctor about all medicines you take, including prescription medicines, over-the-counter medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

Valproic acid medicines, such as Depakene or Depakote
Alcohol or other central nervous system (CNS) depressants
Hormonal birth control medicines, including pills, implants, patches, or injections

Topamax may decrease the effectiveness of hormonal birth control and may increase breakthrough bleeding. Tell your doctor if your bleeding pattern changes.

Do not drink alcohol while taking Topamax. Topamax may cause sleepiness, dizziness, or problems with thinking and coordination.

Topamax is also FDA-approved to treat certain types of seizures.

If you miss one dose of Topamax, take it as soon as you remember. If you are within six hours of your next scheduled dose, skip the missed dose and take your next dose at the regular time. Do not take two doses at the same time.

If you miss more than one dose, contact your doctor.

If you are pregnant, planning to become pregnant, or breastfeeding while taking Topamax, talk with your doctor about the risks and benefits. If you can become pregnant and are not planning a pregnancy, use effective birth control while taking Topamax.

Topiramate passes into breast milk. Sleepiness and diarrhea have been reported in breastfed infants exposed to topiramate through breast milk.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Topamax?

In adult migraine prevention studies, people taking topiramate 100 milligrams a day had larger reductions in migraine headache frequency compared with placebo (an inactive treatment). In two studies, migraine headaches decreased by about 2.1 headaches every four weeks with the 100 milligrams daily dose, compared with decreases of 0.8 and 1.1 with placebo.

With the 200 milligrams daily dose, decreases were about 2.2 and 2.4 headaches every four weeks. In studies of adolescents 12 to 17 years of age, the 100 milligrams daily dose was shown to help prevent migraine attacks.

How long does Topamax take to work for migraine

The recommended dosing schedule for migraine prevention reaches the full recommended dose of 100 milligrams a day by week 4.

Clinical studies showed that Topamax helped reduce migraine frequency during treatment. However, the studies did not identify an exact number of days or weeks when migraine improvement may begin for each person.

Can Topamax cause kidney stones when used for migraine?

Yes. Topamax increases the risk of kidney stones. Drinking plenty of fluids during the day is recommended to help reduce this risk.

The risk may be higher in people taking another carbonic anhydrase inhibitor or in people on a ketogenic diet. People with kidney problems or people receiving hemodialysis may need dose adjustments while taking Topamax.