title: Migraine and topiramate induced dyspnea.
abstract: Topiramate is effective in migraine headache prophylaxis. Pulmonary symptoms are rarely described as adverse effects. We report the case of a 42-year-old woman with migraine headaches who developed chronic shortness of breath while taking topiramate. Our patient experienced hand paresthesiae at a dose of 25 mg daily, and exercise induced dyspnea at doses above 50 mg daily; these symptoms worsened with increasing topiramate doses. Physical exam and chest x-ray were normal. Blood gas revealed a metabolic acidosis. Symptoms resolved after discontinuation of topiramate. Topiramate induces a lowering of blood carbon dioxide, which is usually asymptomatic. This is due to inhibition of carbonic anhydrase at the proximal renal tubule resulting in impaired proximal bicarbonate reabsorption. The decrease in CO(2) blood level facilitates the occurrence of metabolic acidosis. To our knowledge, this is the first case report of topiramate-induced dyspnea in a patient with migraine headaches.
authors.affiliation: Department of Neurology, Hôpital Gui-de-Chauliac, Montpellier Cedex 5, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Delpirou-Nouh
authors.forename: Philippe
authors.initials: P
authors.lastname: Gelisse
authors.forename: Pascal
authors.initials: P
authors.lastname: Chanez
authors.forename: Bertrand
authors.initials: B
authors.lastname: Carlander
mesh_terms: D000328:Adult; D004305:Dose-Response Relationship, Drug; D004417:Dyspnea / Q000139:chemically induced*; D005260:Female; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives*; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy*; D018696:Neuroprotective Agents / Q000009:adverse effects*; D000077236:Topiramate
chemical_list: D018696:Neuroprotective Agents; D000077236:Topiramate; D005632:Fructose