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Re: Starting on Topomax for Migraines. Advice anyone? Mitch

Posted by JohnX2 on November 13, 2001, at 9:48:15

In reply to Re: Starting on Topomax for Migraines. Advice anyone? JohnX2, posted by Mitch on November 12, 2001, at 22:56:23

Thanks for your feedback.

I was getting mad at the neurologist because
he wanted to throw migraine headache medicines
at my tension headaches, and I had absolutely
no symptoms of migraine. Anyways, I did a bit
of research on tension headaches, which are
less vascular, and more related to muscle
contraction spasms. I found that SSRIs can induce
them in an area of the brain where dopamine
counteracts acetylcholine in the stimulation of
the masseter (jaw) muscles. These dopamine neurons
are unique in that they do not contain self
regulating auto-receptors. Their firing is gated
by serotonin receptors (proportional to 5ht-1a
post synaptictic and inversely proportional to
5ht-2a receptors) at the junction and also by
dopaminergic projections from a pool of dopamine
neurons at the VTA where there are other somotodendric
dopamine neurons gated in a similar manner but by
many afferents (it does have the same serotonin
input). The serotonin input can be exacerbated
by stress. Stress can cause greater serotonin
impulses due to interesting cross talk with
the noradrenergic stress center (the locus
coerulus) and all this indirectly can lead to
bruxism and tension headache because of the
goofed up dopamine modulation. In the hypo-dopaminergic
state a dopaminergic med like Adderall makes the
headache go away, so do 5ht-2a antagonists. This
is in the literature and also my experience.
Klonopin slows the firing of those serotonin
neurons and so does buspar, which gives them
potential therapeutic advantages. I was hoping
that maybe Topomax could achieve some of the
same goals as klonopin, but the feedback on it
hasn't been overwhelmingly positive in this



> >
> > Hi,
> >
> > Topomax is one of the few anti-convulsants I have
> > not tried. I have chronic tension headache and
> > bruxism and lately was suggested baclofen. But
> > my older neurologist thouht Topomax may help.
> > I never got substantial relief from the other
> > anti-convulsants, but i am currently taking lamictal
> > and klonopin is the main releaver of my headaches.
> > When I looked into topomax I saw it worked very
> > differently than lamictal and it had action at the
> > GabaA receptor increasing Cl- conductance which is
> > also what klonopin does. So I was still thinking it
> > may be good to try, especially given the latest buzz
> > regarding it being a good adjunct to lamictal.
> >
> > Any thoughts?
> >
> > Thanks,
> > john
> >
> John, tension headaches and migraines are quite opposite from each other with regards to vascular effects. Anything that might be effective for migraines might exacerbate tension headaches and vice versa. Tension headaches that I have experienced often involve excess use of stimulants like caffeine for example, while caffeine tends to help migraine sufferers.
> As far as AED's go: Topamax and Gabitril were the worst for cognitive side effects that I have experienced. I felt like someone rubbed my forehead down with lidocaine and then slugged me with a large Masonic Bible!
> Mitch
> >
> > > > Hi,
> > > >
> > > > I just started (last night first dose) on Topomax as a migraine prophylaxis.
> > > >
> > > > I don't have a history of any psychological disorders. just found this site through a Google search and you guys sound really knowledgeable.
> > > >
> > > > I've had migraines for most of my adult life and in the last few months they've become daily occurences. I've been taking Zomig and Ibuprofen to combat attacks -- have tried lots of other meds, too, both preventive and "abortive."
> > > >
> > > > My doctor, a headache specialist, recommended Topomax based on some very favorable results in his other patients.
> > > >
> > > > I'm a bit worried about side effects. They started me on 15 mg/day to increase by 15 mg each week until either the daily migraines go away or I reach 90 mg/day.
> > > >
> > > > I'm not taking any other neurological drugs.
> > > >
> > > > I'm a bit worried about the side effects. I do feel a bit groggy today but I don't know if it's from the Topomax. Is this commmon? Does it go away?
> > > >
> > > > My doctor mentioned tingling fingers, loss of mental acuity, depression, weight loss (not a negative in my opinion!) and dehydration.
> > > >
> > > > Has anyone experienced any of these? I'm particularly worried about the loss of mental acuity and grogginess since I need my brain power! I'm also worried about depression because I've seen what a horrible disease that can be.
> > > >
> > > > And I'd like to know if the side effects tend to go away with time. If so, how long does it take?
> > > >
> > > > If anyone has any advice, comments, experiences, etc. on taking Topomax for migraines, I'd appreciate it.
> > > >
> > > > Thanks!
> > >
> > >
> > > Hi Inky,
> > >
> > > It seems that more anti-epielpsy meds are starting to be used for migraine prophylaxis. I know Depakote has been used for that and has an approvable indication for that purpose.
> > >
> > > I have tried Topamax for my bipolar. Lots of others here have tried it as well for various things (mostly bipolar disorder). All I can say is that it *can* cause some fairly bad cognitive dulling effects. I wouldn't say that it is all that "depressogenic". As with many meds nowadays you have to start low and go slow with dose increases. I made it up to 50mg/day for a while with other meds added on and I was pretty foggy-headed. Many people here have had little trouble with that if you hang with a dose long enough before you increase it. 15mg to start was where I started. I would continue taking the 15mg/day dose until the "tiredness" or whatever seems to abate *before* you go up a notch in the dosage FWIW,
> > >
> > > Mitch




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