Topiramate headache

In a 10-week randomized, double-blind, study in 64 women with recurrent major depressive disorder, the dosage of topiramate was titrated up to 200 mg/day (1130). There were no serious adverse effects, including psychotic symptoms and suicidal acts. Adverse effects such as headache, fatigue, dizziness, and paresthesia were rated as mild. After 10 weeks there was weight loss, which was usually regarded as beneficial. 

Topiramate is an antiepileptic medication also used in an off-label capacity to treat migraine headaches and bipolar disorders. 

In an open study of the effects of topiramate 100-1600 mg/day in 292 adults (mean age 33 years) with partial and/or generalized seizures previously resistant to antiepileptic drug therapy over 50% of the patients achieved at least a 50% reduction in seizures (1). The most commonly reported adverse events were related to the central nervous system, including headache, difficulty in concentrating, somnolence, anorexia, fatigue, dizziness, nervousness, nausea, confusion, and paresthesia 32% discontinued because of adverse events. 

In a 3-year retrospective review of the use of topiramate in 51 children aged 3-16 years with partial and generalized epilepsy, 15 children had a greater than 50% reduction in their seizure frequency and four became seizure free (4). Adverse effects were reported in 29 patients most were related to behavioral and cognitive difficulties less common effects included anorexia, weight loss, and headache. Topiramate was withdrawn in 25 patients in 20 cases because of adverse effects. 

The efficacy and tolerability of topiramate have been studied in 170 patients with refractory epilepsy (7). The most common adverse effects resulting in withdrawal were fatigue, weight loss, irritability, paresthesia, depression, and headache. Three patients developed renal calculi but continued therapy. 

Wheeler SD, Carrazana EJ. Topiramate-treated cluster headache. Neurology 1999 53 234-236. 

Topiramate is an anticonvnlsant that blocks repetitively elicited action potentials, affects the ability of chloride ion to move into nenrons, and antagonizes an excitatory amino acid receptor. It is indicated as an adjunctive therapy for partial onset seiznres primary generalized tonic-clonic sei-znres seiznres associated with Lennox-Gastaut syndrome and prophylaxis of migraine headache. 

The most common side-effects of topiramate are paresthesia (27%), headache (21%), fatigue (20%), dizziness (14%), somnolence (1 3%), anorexia (11%), and weight loss (11 %). Less common side-effects, but with important clinical implications, are depression (7%), difficulty with concentration (7%), and confusion (5%). " As with other anhydrase inhibitors, topiramate has been associated with kidney-stone formation, and the incidence of nephrolithiasis is estimated to be 2-4 times higher than that expected in a similar untreated population. Many of the central nervous system effects of topiramate, including cognitive complaints, can be managed by gradual introduction and dose escalation. ... 

Topiramate is a sulfamate-substituted monosaccharide derived from fructose with a broad spectrum of AED activity. It is approved for monotherapy or as an adjunct drug for partial or primary generalized tonic-clonic seizures in patients older than 10 years, as adjunct therapy in children aged from 2 to 10 years with partial-onset seizures, and in persons older than 2 years with Lennox-Gastaut syndrome (40,53). Topiramate also is approved for the prophylaxis of migraine headaches. 

In a small, open study of topiramate for the prevention of cluster headache in 12 Asians, the initial dose was 50 mg bd, increasing by 50-100 mg/day every 3-7 days to a maximum of 400 mg/day. Adverse reactions included paresthesia (84%), slow speech (54%), and dizziness (46%). Two patients withdrew because of adverse events. 

Topiramate mean dosage 118 mg/day has been studied in 29 patients, mean age 17 years, with Tourette syndrome in a doubleblind, randomized, placebo-controUed, parallel-group study [287. Headache, diarrhea, abdominal pain, drowsiness/hjrper-somnia, cognitive slowing, and renal stones occurred with similar frequencies in the two groups. 

Lo YL, Lum SY, Fook-Chong S, Siow HC. A pilot study of topiramate dosages for migraine prophylaxis in an Asian population. J Headache Pain 2010 11(2) 175-8. 

Maggioni F, Mampreso E, Mainardi F, Lisotto C, Malvindi ML, Zanchin G. Topiramate-induced intractable cough during migraine prophylaxis. Headache 2010 50(2) 301. ... 

Markowitz SY, Robbins MS, Cascella C, Sheikh HU, Grosberg BM. Reversible hypo-hidrosis with topiramate therapy for chronic migraine. Headache 2010 50(4) 672-4. 

Observational studies Topiramate has been retrospectively evaluated in 227 patients with symptomatic epilepsy, of whom 12 withdrew because of adverse effects [292 ]. The incidence of adverse effects was 36% and the most common were weight loss, memory impairment, paresthesia, headache, and dizziness, most were mild to moderate in intensity and transient. 

All the available evidence for the use of topiramate as monotherapy in patients with newly or recently diagnosed epilepsy has been examined in a systematic review of three randomized, double-bUnd, controlled trials which recruited more than 1000 patients [302 ]. The most common adverse events associated with topiramate 50-500 mg/day generally occurred early in the course of treatment and were nervous system-related effects headache (15-25%), dizziness (12-19%), fatigue (11-23%), somnolence (10-17%), anorexia (8-10%), insomnia (7—10%), and hyperesthesia (5— 10%). Adverse events that were likely to have been related to the carbonic-anhy-drase activity of topiramate (e.g. paresthesia, changes in serum bicarbonate) were frequent (13-35%) but were not usually considered clinically relevant Renal calculi occurred infrequently (1%). The most frequent adverse events during maintenance therapy were headache (20%), reduced appetite (11%), and weight loss (11%). 

Ko5er A, Dikici S, Atakay S, Okuyucu S. Serum uric acid and lipid levels while taking topiramate for migraine. Headache 2008 48(7) 1056-60. 

Drug-drug interactions In a placebo-controlled study evaluating the combination of topiramate and nortriptyline for headache prophylaxis, 44 patients were given topiramate 100 mg/day and nortriptyline 30 mg/day, while 17 took topiramate 100 mg/day plus placebo [174 ]. Side effects reported by those taking both medications, as opposed to topiramate alone, included dry mouth (18%), somnolence (9%), hair loss (2.3%), heartburn (2.3%), dry mouth (4.5%), and memory disturbance (6.8%). 

Krymchantowski AV, da Cunha Jevoux C, Bigal ME. Topiramate plus nortriptyline in the preventive treatment of migraine a controlled study for nonresponders. J Headache Pain January 2012 13(l) 53-9. 

Chakor RT, Bharote HS. Topiramate-valproate-induced encephalopathy in migraine. Headache September 2012 52(8) 1321-2. 

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