For severe migraines it might be useful to employ a temporary prophylactic therapy next to the treatment of the attacks. Several substances are available which differ in their effect and as well as their side effects. The choice has to be made in every individual case since every patient has different prerequisites such as special forms of migraine or accompanying disorders.
Topiramat is approved in Germany under the name Topamax Migräne. The medication is supposed to decrease the frequency as well as the severity of the migraine attacks. The exact mechanism of effects on migraine is not yet known but studies and experiences with Topiramat were so convincing that the substance is a medication of first choice for migraine prophylaxis by now. The substance has been used for treating epilepsy for a while. There it is a standard medication by now and is used for life long therapy. For a start, you are supposed to take the medication for 6 to 9 month, as all other prophylactic medication. It is necessary that you keep marking your migraine attacks in your calendar so that you and your doctor can document and control the prophylactic effect of the medication.
The daily dose for migraine prophylaxis is lower that for epilepsy and is between 50 to 200 mg and can be taken in a single or two separate doses. 100 mg have proven to be the ideal dose for most patients. Your doctor will give you the individually necessary dose.
Most patients tolerate the medication well. As more common but harmless side effects tingling sensations in, for example, arms and legs can occur and are mostly temporarily. In some cases a temporary potassium dose can help. Sometimes, slight changes in taste for example for sweet dessert can occur. Maybe this is the reason why weight loss occurs in some patients over the course of the therapy. Enough fluids should be drunk (about 3 liters a day) to prevent kidney stones.
Most of the patients benefit from the medication if tolerated. In some patients trouble concentrating or disorders of the memory can occur. Also, in some very sensitive patients, changes in the mood with depressive disorders can occur or worsen. In this case it has to be decided if a reduction of the dose is possible or if the patient is unsuitable for the substance and if an alternative medications should be considered.