Topiramate can be very effective for the prevention of migraines in patients who normally experience three or more migraine headaches per month. This medication was originally approved for the treatment of epilepsy, a seizure condition which may involve some of the same brain pathways as migraines. The exact mechanisms behind how topiramate works for migraines are not known, but the drug has performed well in a variety of studies and may be considered as an option for some patients. To be most effective, it must be used as directed.
This drug is not intended for use in the treatment of acute migraine attacks. Instead, patients take a daily dose to dilate blood vessels in the brain, reducing the risk of developing a migraine. In clinical trials, topiramate for migraines outperformed placebos, indicating that it could be an effective treatment tool. Further studies on populations of patients using the medication in the long term were also supportive.
Another benefit of topiramate for migraines is that it appears to be well-tolerated by patients. People typically experience minimal side effects, and while it does have drug interactions, they are lower than those with some other medications. This can make it easier for people to safely adhere to treatment and stay on the medication as long as they need to use it. For patients at risk of migraines for life, this may involve years of topiramate for migraines to successfully manage the condition.
Even while on topiramate for migraines, it is still possible to experience headaches. Patients can work with a neurologist to monitor migraines and potential side effects like cognitive impairments which can appear in some patients. The medication can be sedating, which may be irritating for the patient during the adjustment period. If it is withdrawn, it is important to do so under supervision to make sure the dosage is slowly stepped down and the patient receives appropriate treatment for any complications.
Doctors may not recommend topiramate for migraines in all cases. This medication is most suitable for patients with serious headaches that interfere with the ability to perform routine tasks on a regular basis. Patients who experience disabling headaches of this nature may need aggressive medication management to keep their condition under control. For people with less frequent or more mild headaches, the risks of medication can outweigh the benefits of preventing the occasional migraine, even if it is unpleasant. They may be better candidates for therapies provided as-needed to treat migraines when they happen.