This review focuses on the use of Topamax (topiramate) for the treatment of headaches, especially migraine headaches. Topamax was originally approved as an anticonvulsant, but has been approved by the FDA for use as a treatment in preventing and reducing the frequency and severity of migraine headaches.
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What is a Migraine?
Migraines can best be described as a recurring headache with intense throbbing pain that is usually located on one side of the head. An attack typically lasts from 4 to 72 hours. The following types of migraine headache have been identified:
Migraine without aura (common migraine): This type accounts for 80% of migraine headaches. There is no aura before a common migraine.
Migraine with aura (classic migraine): This type is usually preceded by an aura and is usually much worse than a common migraine. Most often, an aura is a visual disturbance (outlines of lights or jagged light images).
Status migrainosus: This is the term used to describe a long-lasting migraine that does not go away by itself.
Migraine headaches affect roughly 15% of people and over 80% of them have family members who also get migraines. Three times as many women as men get migraines. The exact cause of migraines remains unknown. Certain chemicals normally found in the brain (namely, dopamine and serotonin) may be involved in causing migraines. These chemicals are called neurotransmitters because they transmit signals within the brain. Neurotransmitters can cause blood vessels to act in unusual ways if they are present in abnormal amounts or if the blood vessels are particularly sensitive to them. Various triggers are thought to bring about migraine in people who have a natural tendency for having migraine headaches. Different people may have different triggers. Common triggers include foods like chocolate, cheese, nuts, alcohol, and monosodium glutamate (MSG); missing a meal; stress and tension; birth control pills (women often have migraines at the end of the pill cycle. This is called an estrogen-withdrawal headache).
Topamax is mainly used as an anticonvulsant. It affects chemicals in the brain that help to reduce seizure activity. It is also used to prevent migraine headaches. Topamax will only prevent migraine headaches or reduce the number of attacks. It will not treat a headache that has already begun. Patients taking Topamax to prevent migraines generally take dosages varying between 25 and 400mg daily.
Common side effects: drowsiness, dizziness, tingling sensations, loss of appetite and weight loss, difficulty concentrating
Side effects that should be reported promptly: unsteadiness, slowing or shakiness, speech problems, mental/mood changes, stomach/abdominal pain.
Unlikely but report promptly: itching, trouble or rapid breathing, fast/slow/irregular heartbeat, loss of consciousness, fever, persistent sore throat.
Seek immediate medical attention if any of these rare but very serious eye problems occur: sudden vision change/blurred vision, eye pain or redness. Infrequently can cause decreased sweating, which could raise your body temperature (hyperthermia).
Topamax has been associated with some rare, but serious adverse effect including:
-lowering of bicarbonate levels in the blood - Measurement of baseline and periodic serum bicarbonate is recommended.
-Acute myopia and secondary angle-closure glaucoma - patients should be cautioned to seek medical attention if they experience blurred vision or ocular pain.
-Hyperthermia - decreased sweating and increased body temperature, especially in hot weather
-Cognitive/psychiatric side effects including cognitive dysfunction,
About My Headaches
To help you understand how Topamax has worked for me, I will first share a bit about my headaches. I have suffered from tension and migraine headaches for nearly 20 years. For the most part my headaches were not debilitating. They were of great annoyance and most definitely uncomfortable, but I have only missed a few days of work because of them. My headaches gradually increased in frequency and duration and were at their worst when I was in my late twenties through my mid-thirties when I finally sought treatment last fall. Prior to this, I just accepted my frequent headaches, and took Excederin whenever I felt a headache coming on and hoped it would go away--sometimes they did, sometimes they didnt.
I get both tension headaches and migraine headaches. A tension headache is a general description for headaches that are usually caused by environmental factors and/or stress. Mine are not stress related, but are caused by a combination of factors including: poor posture, skipping meals, wearing hats, pulling my hair back, hormonal changes, and other medications. Even though I have figured out these causes, and did everything I could to avoid these potential headache causes, I was still having frequent headaches. When I was unable to get rid of my tension headaches, they would progress for hours, then days, and I would then end up with a migraine headache.
My Experience with Topamax
After having one of my more severe migraines last fall (2 and a half days long and vomiting), I finally called and made an appointment at a headache clinic that my mom recommended that was newly covered by my health insurance. I met with a neurologist, who heads the headache clinic, a dietitian, a physical therapist, and a psychologist. I also had an MRI on my head to rule out any more serious cause. After ruling out psychological and dietary causes to my headaches, I underwent 8 weeks of physical therapy to correct some posture issues and muscle tightness in my neck. This has helped. I was prescribed Relpax to take if I do get a migraine (this medicine works great for migraines that have already begun).
On my next visit my doctor prescribed Topamax. She said that the Topamax may even help reduce my daily tension headaches because the medication works by desensitizing the brain to the headache pain. I see my doctor periodically (ranging from monthly to every 3-4 months) so she can monitor my status. I also have to have blood drawn every 6 months while on Topamax to make sure that everything is in check. (Topamax can lower bicarbonate levels in the blood). My doctor also advised me to drink plenty of water while taking this medicine to prevent kidney stones.
I started off by taking 25mg at bedtime which is considered a very low dose. According to my doctor, most of her patients seem to see the best results at about 100mg. About an hour after taking it, I noticed a tingling sensation in my toes, which is one of the most common side effects. It felt pretty much like the feeling you get when your foot falls asleep, except that the sensation lasts for only about a minute and it comes and goes in my fingers and toes. The next morning I woke up with a headache that I knew was due to the medication (not like my regular daily headaches). I am sensitive to new medications, so I assumed that this would pass after a few days of taking this new medication. I woke up with a headache for the next five days after beginning this medication. These headaches went away simply by taking two Excederin tablets. I also noticed that I felt sleepier than usual about an hour after taking the Topamax, but this was not a problem because I was taking it at bedtime. After the first week of taking this medicine, I no longer felt sleepy after taking it, nor did I ever wake up with a headache caused by it.
My Side Effects
For about two weeks after beginning to take Topamax, I experienced several other common side effects. Most of these side effects subsided within two weeks or so, and if they had not, I probably would not have been able to continue with the medication. One of the more serious and annoying side effects that I experienced after beginning Topamax was difficulty concentrating. I found it hard at times to pay attention at work, or to find the right word to say. It often felt like the word I wanted to say was on the tip of my tongue, but I just could not get find it. In addition to the minor tingling in my fingers and toes, I began to experience numbness in my nose, roof of my mouth, and upper lip. I also experienced appetite loss that was quite severe at first, making me have to force myself to eat for a week. I regained my appetite to almost normal as I got used to the medicine. In addition, as a result of taking this medication, I am unable to taste carbonation. Carbonated soft drinks and beer taste flat to me. I actually didnt notice this right away because I dont drink much soda anyway, so this wasnt a big deal for me. This side effect continues today. My doctor did not like to hear that I had so many side effects as a result of taking Topamax, especially the cognitive ones, but she stated that they are common when first starting the medication, and it was fine to continue taking it since the side effects had subsided.
I experienced my worst side effects when just starting out on the medication. My dose has been gradually increased to 100mg, and with each dosage increase, I notice a slight dip in my appetite and a bit of tingling in my fingers and toes. Over the course of eight months, I have lost about 15 pounds even though I have very little appetite loss any longer. (I guess that is a positive side effect!) The side effects vary from patient to patient and can vary depending on the dosage as well. For example, my mom takes Topamax as well, and has not experienced even a single side effect.
Over the course of the past eight months, my dosage has been gradually increased to 100mg per day (50mg at bedtime, and 50mg in the morning). During this time period, my headaches have gradually decreased in frequency and duration. When I first started taking Topamax, I went for 3 full months without a single migraine! I have not gone that long without one since, but my attacks are much milder than they used to be. My migraines also respond much better to my migraine medicine, Relpax, which is meant to be used after the onset of an attack. Since beginning Topamax, my migraines respond to Relpax in one dose (never two) and my headache is always gone within an hour. I only used Relpax for a short time before beginning the Topamax, and I did achieve good results with it, but now I achieve great results!
I have had a dramatic decrease in the number of tension headaches I get also. I used to get headaches almost every day. I now get headaches about twice per month. This has been the biggest benefit. These tension headaches are generally what led to most of my migraines, and by eliminating most of them, I have significantly reduced my migraines as well.
Since my doctor and I were unable to find a definitive cause(s) for my headaches, we had initially set a realistic goal of reducing my headache frequency to one very mild headache per week (It is unrealistic to think that I would be 100% headache free). Once I achieved this goal, I would maintain that current dose for about 6 months, and then begin to be weaned off of the Topamax gradually as long as the headaches do not increase in frequency. Things have been going great. In October I will see my doctor again, and at that point she plans on reducing my dosage. Topamax has been shown to have lasting effects on the brain after about 6 months of continued use. I am hoping that I will no longer need this medication after too much longer.
Topamax has been great for me in reducing my headaches dramatically! After dealing with side effects for the first couple of weeks, I have been able to tolerate this medicine quite well. I did have to learn to be patient, because this medicine takes time to work and seems to work better and better over time. I realize this is definitely not for everyone, but if you are plagued with migraines, or even chronic tension headaches, it might be worth trying.
Topamax can be expensive if you dont have prescription drug coverage depending on the dosage that is prescribed. For a 30 day supply of 50mg tablets (to be taken twice daily) at Walgreens, the cost is around $295. Pretty pricey!
More information is available at Topamax.com
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