Topamax for Migraine: Dosage, Precautions and More

Woman on Bed Feeling Migraine
Medically reviewed by Dr. Mavra Farrukh

Key Takeaways

  • Topiramate is used to treat seizures and to prevent migraines; the medication can not be used to treat migraine.
  • Before taking Topiramate, you should follow the guidelines provided by your healthcare provider.
  • Every time you get a refill for Topiramate, you should discuss all the medications you are taking with your doctor.


A migraine is characterized by mild to severe pain on one side of the head. Many people might not believe you when you say you have a migraine, while others can’t comprehend how terrible it is when you are in the midst of one. Medication and advice from an expert can alleviate symptoms, though. Topiramate is one medicine that can help prevent migraines. To lessen the frequency of migraine attacks, Topamax is prescribed as a preventative medication. This aids in the treatment of epilepsy and seizures as well. It should be noted that Topiramate can only prevent migraines. You can’t use it to alleviate a headache that you are already experiencing.

How does Topamax help in managing migraines?

The exact mechanism of action for Topamax has yet to be discovered. However, Topamax calms the overactive nerve cells in the brain, which are associated with migraine attacks. During a migraine, the overactive nerve cells are believed to send pain signals. These overactive nerve cells are suppressed during migraines by using Topamax, which reduces the frequency of migraine attacks. This way, Topamax helps prevent migraines however, the medication is ineffective once the migraine attack has already occurred.

Have you been prescribed Topamax for migraines? Connect with our doctor to get a refill.

How to use Topamax?

Swallow a whole tablet of Topamax and avoid chewing or breaking the tablet. You can take the tablet with a glass of water with or without food. It is recommended to take a 50mg tablet twice a day for the prevention of migraine. For migraines, you will typically need to take Topamax for six to twelve months. Topamax helps reduce the frequency of migraines if taken regularly, as advised by your doctor.

Dosage forms

Dosage forms of Topamax include coated tablets that are swallowed and sprinkle capsules that you can open and sprinkle over a small amount of soft food and engulf. The coated tablets come in strengths of 25mg, 50mg, 100mg, and 200mg, while the sprinkle tablets come in dosage forms of 15 and 25mg. 

It is important to note that Topamax is an anticonvulsant drug and is used to treat epilepsy as well as prevent migraines. A qualified doctor prescribes the dosage forms and strength, depending on your condition and other medications you may be taking.

Drug Interactions of Topiramate

Some important drug interactions of Topairamate include birth control pills, especially those containing estrogens, which will not work if taken with Topamax. Other medications, such as Hydrochlorothiazide and Pioglitazone, also interact with Topiramate.

It is recommended to use additional contraceptive measures with estrogen-containing birth control pills such as condoms and spermicide. If you want your doctor to make an informed decision about your medication, it’s important to tell them everything you are already taking.

Need a migraine treatment? Our doctor can customize treatment plans with Topamax and other effective options.

Other Interactions

A ketogenic diet, such as taking in more fats and less carbs and proteins, can increase the risk of high acid levels in your body fluids with Topiramate. The condition is also called metabolic acidosis. Topamax has no major interaction with other food items, vaccines, vitamin supplements, or herbs.

Topiramate Alternates for migraines

Propanolol, Nurtec ODT, Atogepant, Amitriptyline, and Onabotulinumtoxin Type A can be used as an alternate option for migraine other than Topiramate. Your healthcare professional will decide which one is best for you.

How long does it take Topamax to start working?

It may take 8 to 12 weeks for Topamax to start working fully for your migraine. It has been observed that Topiramate takes up to three months to exert its full effects for the prevention of migraines. If you observe any unusual symptoms while taking Topamax, discuss your symptoms with your doctor.

What are the common side effects of Topamax?

The common side effects of Topamax include: 

  • Diarrhea
  • Loss of appetite
  • Weight loss
  • Feeling sick
  • Feeling sleepy
  • Feeling depressed
  • Clumsiness
  • Blurred vision
  • Confusion
  • Eye redness or pain
  • Unsteadiness
  • Generalized slowing of both mental and physical activity
  • Memory problems
  • Increased eye pressure
  • Unusual tiredness or weakness

Rare side effects of Topiramate may include:

  • Osteoporosis in adults
  • Aggression
  • Rickets in children
  • Agitation
  • Fever
  • Loss of appetite
  • Sore throat
  • Weight loss
  • Difficult or painful urine
  • Itching or skin rash
  • Swelling
  • Trouble breathing
  • Nose bleeds
  • Pale skin
  • Lower back pain
  • Ringing or buzzing in ears
  • Loss of bladder control

What are the precautions while taking Topamax?

It is recommended to avoid taking alcohol with Topamax. It is also recommended to avoid dangerous activities like swimming and climbing in high places and avoid heavy exercise while taking Topiramate.

Got questions about Topamax? Contact a qualified professional to discuss your concerns right away.

How do I stop treatment with Topamax?

Topamax should not be stopped abruptly. If you are taking it to prevent migraines, you should discuss it with your doctor rather than abruptly leaving the medication. For epilepsy, it is recommended to reduce the dose by 25-50mg every week to avoid any withdrawal symptoms. 

What if I miss a dose?

If you have missed a Topamax dose and have less than eight hours left before your next dose, it is recommended to avoid double dosing. If you have more than an eight-hour gap between your next dose, take the medication as soon as you remember.

When should I see a doctor?

If you get pregnant while taking Topiramate or if you have severe side effects like blurred vision, rapid breathing, bone pain, or loss of consciousness while on Topamax, immediately discuss your condition with your doctor.

Can Topamax be safely used during pregnancy or while breastfeeding?

No, Topamax can cause major disorders of the brain and disabilities like major congenital malformations if you take it during pregnancy. In the case of breastfeeding, the medication passes into breast milk and can cause your baby to be sleepy and irritable. Therefore, your doctor will decide whether you can take Topiramate while breastfeeding.

Can Topamax lead to metabolic acidosis, and how is this risk managed?

Yes, Topiramate can cause metabolic acidosis. The risk is managed by avoiding the keto diet with the medication. Furthermore, if you still develop metabolic acidosis due to Topiramate, your healthcare provider will discontinue it immediately.

Is Topamax and Gabapentin the same thing?

No, they are different medications that belong to the same class. Topiramate (Topamax) and Gabapentin (Neurontin) are anticonvulsants used to treat epileptic seizures. However, Topamax is also used for the prevention of migraines, while Gabapentin is also used for nerve pain caused by shingles.

Will my hair grow back after stopping Topamax?

Yes, hair loss caused by Topamax is reversible. If you lose hair while taking the medication, you will observe your hair growing back once you stop taking Topamax.

Is Topiramate bad for your heart?

No, there aren’t any cardiovascular risks associated with Topiramate; however, you may observe metabolic side effects while taking Topamax.

Can Topamax stop your period?

Yes, menstrual irregularity is a significant side effect of Topamax, and it is recommended to report it to your doctor if you notice any changes in your period while taking this medication.

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