title: Safety of topiramate for treating migraines.
abstract: BACKGROUND
  Migraine is a very common medical disorder characterized by attacks of moderate-severe headache, nausea and disability. Topiramate is an effective, popular prophylactic migraine treatment, which is approved for use in adults and adolescents. Due to its multiple mechanisms of action, topiramate has multiple potential safety issues, including systemic and CNS adverse events, which may complicate therapy.
  
  
  METHODS
  This review evaluates common adverse events as seen in the pivotal trials of topiramate for migraine as well as those observed in postmarketing studies. These include weight loss, metabolic acidosis, renal calculi, acute angle closure glaucoma, visual distortions and cognitive slowing. Topiramate use during pregnancy is associated with an increased risk of cleft lip. This review highlights both common and unusual safety issues associated with topiramate use, including important drug interactions and a comparison with other migraine prophylactic agents.
  
  
  CONCLUSIONS
  Topiramate is highly effective in migraine prophylaxis but clinicians using the drug need to be aware of the potential for bothersome or serious adverse events. When treating with topiramate, use a slow titration to the goal dose of 100 mg or the lowest dose, which helps prevent migraine.
authors.affiliation: Thomas Jefferson University, Jefferson Headache Center, Department of Neurology , 900 Walnut Street, Suite 200, PA 19107 , USA +1 215 955 2243 ; +1 215 955 2060 ; michael.marmura@jefferson.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Marmura
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002971:Cleft Lip / Q000139:chemically induced; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D005260:Female; D005632:Fructose / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D008881:Migraine Disorders / Q000188:drug therapy*; D011247:Pregnancy; D000077236:Topiramate
chemical_list: D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose
keywords: metabolic acidosis; migraine; palinopsia; preventive treatment; topiramate