Topiramate for Migraine Treatment: New Information

Learn about this medication for migraine, how effective it is at treating the disease and its potential side effects.

Topiramate is a medication originally used to treat epilepsy, but evidence has shown that it could be effective in treating migraine. Read on to learn how topiramate may help your migraine, its side effects and what to be aware of. Remember, always talk with your doctor first to see if topiramate is suitable for you and your treatment plan.

Results From Clinical Trials

Clinical trials have earned topiramate its FDA approval for migraine treatment. In one trial, a large, randomized, placebo-controlled study indicated that topiramate may be an effective preventive treatment for patients with chronic migraine (15 or more headache days per month).

In a different head-to-head study, patients with chronic migraine responded equally well to topiramate versus onabotulinumtoxinA (Botox®) injection therapy. The results showed that both medications were effective for reducing the total number of migraine days per month in patients with chronic migraine. However, the group generally preferred the onabotulinumtoxinA due to its more favorable side effect profile and because injection therapies act faster compared to oral medications.

Nonetheless, topiramate has shown promising results in its effectiveness in treating migraine.

Speak With Your Doctor

Topiramate can be taken as a tablet, a sprinkle capsule (contains medication that can be sprinkled on food) or a liquid taken by mouth. Topiramate may not be suitable for some people with certain conditions. If you’re considering topiramate, be sure to inform your doctor about any of the following:

  • If you’re pregnant or planning to get pregnant.
    • Topiramate increases the risk of cleft lip or, less commonly, cleft palate in babies.
  • Liver or kidney conditions. Especially a history of kidney stones.
  • Any metabolic disorders
  • Porphyria, a rare, inherited blood disorder.
  • Other medications including non-prescription drugs, herbal medicines and complementary medicines.
  • Any allergies to medications.

Side Effects of Topiramate

As with any “brain active” medication, topiramate comes with a set of possible side effects. Side effects vary between each person, but they may include:

  • Gastrointestinal issues, such as nausea and, more rarely, diarrhea.
  • Dizziness
  • Fatigue
  • “Pins and needles” sensation in hands, face and feet that usually comes and goes
  • Mental cloudiness and trouble with remembering things
  • Mood changes
  • Increased risk of kidney stones
  • Very rare risk of a rare form of glaucoma (acute angle closure glaucoma)

Other side effects include carbonated beverages tasting “flat.” Some patients experience appetite suppression but rarely leads to significant weight loss.If you are experiencing vision problems, feelings of depression and/or mood swings, let your doctor know immediately.

The migraine doses of topiramate are much less than the seizure doses of topiramate. This helps minimize the side effects.

If you’re taking topiramate, keep track of any and all side effects you may experience when taking it. We recommend writing them down and making note if they have any effect on your migraine symptoms.

Topiramate is not a cure for migraine, but it can effectively treat its symptoms. If you are considering topiramate as part of your migraine treatment plan, be sure to talk with your doctor about the right dosage and what you can expect from this treatment.

The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.

Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.