Topamax for migraine prevention
Topamax is a medication that is very often prescribed for (chronic) migraine. Topamax is in essence an anti-epileptic drug, but it is also prescribed with the aim of preventing migraine. The active substance is topiramate.
Topamax is not the first-line medication. It is prescribed when beta-blockers or the antidepressant amitriptyline cannot be prescribed because of contraindications.
Contraindications for beta-blockers are low blood pressure, low heart rate and asthma. If you know that headache tends to be correlated with low blood pressure, many patients already don’t qualify for a beta-blocker. Amitriptyline is not prescribed when someone wants to become pregnant, in cardiovascular conditions or in people over 65. In women of childbearing age (obviously a strongly represented group among people with migraine), amitriptyline will therefore often not be an option either.
So the chance that you will be prescribed Topamax is quite high. Given the many side effects of Topamax, though, it is important as a patient to be fully informed. In this post I go through the side effects of Topamax, so that you as a patient can make an informed choice.
Summary of the side effects
The list of side effects is particularly long and can be read in the patient information leaflet. Because many side effects fall into the same category, I will focus here on a summary of the most common side effects:
- According to the leaflet, more than 10% of users can develop a new depression or a worsening of an existing depression. Up to 10% of users can also get other depression-like symptoms such as anxiety, irritability and mood swings.
- More than 10% of users can have mouth, nose and throat problems such as a blocked nose, runny nose or sore throat; up to 10% a dry mouth and nosebleeds; up to 1% bleeding gums, increased saliva production, drooling and bad breath.
- More than 10% of users can have problems related to digestion (nausea and diarrhoea), or loss of appetite, vomiting, constipation, abdominal pain or discomfort, indigestion, and stomach or intestinal infection (up to 10%). Weight loss is also reported, which seems a logical consequence.
- More than 10% of users can have sensory problems such as tingling, pain and/or numbness in various parts of the body.
- More than 10% of users can develop anaemia (low blood cells); up to 1% a decrease in platelets (blood cells that help stop bleeding), a decrease in white blood cells that help protect you against infection, and a decrease in potassium in the blood. A decrease in platelets may also be related to the nosebleeds and bleeding gums mentioned earlier.
- Up to 10% of users have trouble with temperature regulation, including fever and reduced or no sweating (up to 1%).
- Up to 10% of users can develop behavioural problems (aggression, agitation, anger, abnormal behaviour); up to 1% thoughts of seriously harming themselves, or attempts to seriously harm themselves.
- Up to 10% of users can develop cognitive problems, including problems with memory, concentration and speed of thinking, or become drowsy or tired.
- Up to 10% of users can develop kidney problems such as kidney stones, frequent urination or pain when urinating.
- Up to 10% of users can get epileptic seizures.
- Up to 10% of users can experience dizziness or a spinning sensation.
- Up to 10% of users can develop motor problems such as difficulty speaking or a speech disorder, slurred speech, clumsiness or poor coordination, feeling unsteady when walking, being less able to carry out routine tasks, involuntary trembling or shaking, muscle cramps or twitching, muscle pain or muscle weakness. Many of the motor problems listed are eye-related, such as rapid uncontrollable eye movements, double vision, blurred vision, reduced vision, difficulty focusing the eyes and eyelid twitching.
- Up to 10% of users can have allergic reactions (such as rash, redness, itching, a swollen face, hives).
- In up to 1%, acidification of the blood (acidosis) is found. According to the leaflet, this can cause problems such as breathing problems including shortness of breath, loss of appetite, nausea, vomiting, excessive tiredness and a fast or irregular heartbeat. Many of the more common side effects could therefore potentially be caused by (undetected) acidification of the blood.
Many of the less frequently reported complaints concern more eye problems (in addition to the motor-related eye problems already mentioned), such as glaucoma, loss of part of the field of vision, inflammation of the eye (uveitis) with symptoms such as redness of the eye, pain, sensitivity to light, watery eyes, seeing spots or blurred vision, maculopathy, blindness in one eye, temporary blindness, night blindness, lazy eye, and swelling in and around the eyes.
Make an informed choice
As a patient, it is crucial to be well informed when you start a medication. If you want to look beyond medication at what is driving your migraine, the Building Block Analysis maps your underlying causes.
