Topiramate to prevent migraine

About topiramate

In people with migraine, it is thought that some chemicals in the brain increase in activity and, as a result, parts of the brain then send out confused signals which result in the symptoms of headache and sickness. Why people with migraine should develop these chemical changes is not clear and many migraine attacks occur for no apparent reason. For some people, however, there may be things which trigger an attack, like certain foods or drinks.

Topiramate is classed as an antiepileptic medicine. It is usually used to prevent seizures in people with epilepsy and there is another leaflet called Topiramate for epilepsy which gives more information about this. However, topiramate has also been found to prevent migraine attacks from occurring. When used for migraine, it may not completely stop every migraine attack, but the number and severity of attacks are often reduced.

Before taking topiramate

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking topiramate it is important that your doctor knows:

• If you are pregnant, trying for a baby or breastfeeding.

• If you have any problems with the way your liver works, or with the way your kidneys work.

• If you have a rare inherited blood disorder called porphyria.

• If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.

• If you have ever had an allergic reaction to a medicine.

How to take topiramate

• Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about topiramate and will provide you with a full list of the side-effects which you may experience from taking it.

• Take topiramate exactly as your doctor tells you to. It is usual to start topiramate treatment on a low dose (25 mg at night), and then for the dose to be increased gradually. A usual maintenance dose is 50-100 mg daily, taken either as a single dose or divided into two doses over the day.

• Swallow topiramate tablets with a drink of water. Do not chew the tablets as they have a bitter taste. If you have been prescribed capsules, you can swallow the capsules in the normal way with a drink of water or, if you prefer, you can open up the capsule and sprinkle the contents on to a spoonful of some soft food (porridge, yoghurt or custard for example). Do not chew the contents of the capsules.

• It is important that you drink plenty of water while you are taking topiramate. This is because there is a slight risk that kidney stones can develop and drinking plenty of water reduces this risk.

• Try to get into a habit of taking topiramate at the same time(s) each day. You can take topiramate before or after food.

• If you forget to take a dose, take it as soon as you remember unless it is nearly time for your next dose, in which case leave out the missed dose. Do not take two doses together to make up for a forgotten dose.
  

Getting the most from your treatment

• Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress. You may need to have eye tests and weight checks from time to time.

• You need to take topiramate every day. Stopping suddenly can cause problems and your doctor may want you to reduce your dose over a few days if this becomes necessary.

• This medicine is used to help prevent migraines, although it is unlikely to stop your migraine attacks completely. If a migraine attack occurs, you can take painkillers or a triptan to treat the pain during an attack.

• A number of things can trigger migraine in some people. These can include some foods (for example, cheese, chocolate, and red wine), worry, bright sunlight, too much or too little sleep, and skipping meals. If you are not sure if these things trigger a migraine for you, it may help for you to keep a migraine diary. Note down when and where each migraine attack started, what you were doing, and what you had eaten that day. A pattern may emerge and it may be possible for you to avoid some of the things that trigger an attack.

• Some people who get frequent migraine attacks are in fact getting medication-induced headache. Medication-induced headache (also called medication-overuse headache) is caused by taking painkillers too often. If you use painkillers on more than two days a week on a regular basis, you may be at risk of this. You should talk with your doctor if you suspect it.

• You must avoid getting pregnant while you are taking topiramate. Make sure you have discussed with your doctor which types of contraception are suitable for you and your partner.

• If you buy any medicines, always check with a pharmacist that they are suitable to take with your other medicines.

Can topiramate cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with topiramate. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Important: topiramate has been associated with a number of serious unwanted effects. Although these occur less commonly than the side-effects listed above, you must let your doctor know straightaway if you notice either of the following:

• Problems with your eyesight.

• Mood changes, distressing or depressed thoughts, or feelings about suicide.

If you experience other symptoms which you think may be due to the medicine, speak with your doctor or pharmacist for further advice.

How to store topiramate

• Keep all medicines out of the reach and sight of children.

• Store in a cool, dry place, away from direct heat and light.

• The oral liquid medicine keeps for one month after first opening. After this time make sure you use a new bottle. It is a good idea to write the date you opened the bottle on the label.
  

Important information about all medicines