Dr. Krusz is a recognized expert in the fields of
headache and Migraine treatment and pain treatment
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Teri,

I wrote to you some time ago, I was on Topamax and the neurologist upped it from 100 to 200 mg plus gave me a new anti depressant to take along with my Celexa and I was having a terrible time with it, felt like I was having brain tremors and the doc said it was not from the meds and then finally stopped everything and told me to go see a shrink that it could not be from the meds. Well I never went anywhere for the past few months, about 3, and I am having headaches for the past three weeks so I finally broke down Wednesday and went to my family doctor. He started me on Topamax again, 100mg. I told him I thought that was too much to start off with and he said it was a low dose. Well I took it and felt like crap. I am just so disgusted. Yesterday I called and told him I want to start out lower so he said to start at 25 mg for two weeks then up it to 50 mg for two weeks. He also gave me 50 mg of Zoloft because he said the serotonin helps with migraines. I feel a little spacey today even on the 25 mg that I took yesterday and I did not take anything yet today. I do not remember feeling this way on Topamax before and I hope after I get used to it I will not feel this way. I am kind of scared to take it now after what happened to me on the 200 mg. I really felt like I was going to die. I could actually feel my brain or something in my head shaking. Is it normal to feel this way starting out on this medicine, I feel like kind of really relaxed, and not too focused? I am also worried about the eye problems. I really can't keep having headaches and taking Maxalt everyday, but is this Topamax safe? As you probably notice, I am kind of afraid of taking drugs, since that last episode. Will I feel normal once my body gets used to Topamax again like before? Thanks for any help. You are so great. Who would I vent to? Who would listen? Thank you so much.
Karen

REPLY:
Karen,

I've sent this on to Dr. Krusz, but we have so many questions that it takes him awhile to answer. In the meantime, here's an article with info on Topamax:

Topamax for Prevention: Proper Dosage and Taper
Topamax (topiramate), a medication originally developed for seizure control, has been prescribed for several years now for prevention of cluster headaches and Migraine attacks. Here's important information about how to best use this medication.

I can't predict how you're going to react to the Topamax, but Dr. Silberstein, when I interviewed him, stressed that it was very important to start at a low dose and taper up slowly AND that it's important that it be taken twice a day rather than taking the day's full dosage at once. He told me that people are far more likely to experience side effects and be unable to take Topamax if it's not prescribed and take correctly. You might even want to print out that info for your doctor since info on how to prescribe Topamax for Migraine prevention isn't in the prescribing information. Even if he's someone who usually dismisses info from the Internet, he should be willing to accept information that came from someone as prominent in the field as Dr. Silberstein.
Teri Robert

Dear Karen:
I agree with Teri and I would further slow down the Topamax rate of dosing. I typically start 12.5 mg for 7-10 days and then upward slowly. I have very few dropouts due to side effects from the medication. Maybe I've just been lucky. If not Topamax, then perhaps one of the other neuronal stabilizing agents in that "family"?
John Claude Krusz

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