topamax and amitriptine dosage

Thanks so much for your questions, As we wait for others to chime in on this topic, here is a link to some articles/forums relating to others' experiences with Topamax/topiramate https://migraine.com/search?s=topamax and here is another link for community members' experiences with https://migraine.com/search?s=amitriptyline Hoping this helps as you go about finding just the right treatment for your migraines. Wishing you relief and good health. Rebecca (Migraine.com moderator)

Thank you for sharing your concerns with us. I get it, starting new medications can be frustrating, we just want the pain to stop!!
Here's the thing - Topamax is a medications best started at a low dose (25 mg a week) and increased very slowly. Some people may need a slower taper than others. Here is the dosing information from the manufacturers site https://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/TOPAMAX-pi.pdf. The migraine dosing is on pg 5.
Having said that, when we start new medications, it can take up to 90 days at the therapeutic dose before we see improvements. The bottom line is it can take some time. It's important to give each medication a fair trial so we know which ones really work. I hope that makes sense!

Is your doctor well versed in treating migraine and headache disease? If not it may be time to reach out to a doctor who is a true expert in treating migraine and headache. These doctors are different from general neurologists as they are certified in headache medicine, all neurologists are not. General neurologists may be fine doctors but have a hard time being experts in one area because they treat many conditions such as stroke, epilepsy, multiple sclerosis, Parkinson's and more. A true migraine/headache disease doctor treats migraine and headache all day, every day. Here is more information on how these doctors are different and how to find one;
https://migraine.com/blog/really-find-headache-specialist/
https://migraine.com/living-migraine/neurologist-vs-specialist
https://migraine.com/living-migraine/change-thoughts-new-care.
We're here for you! Please let me know what you think and I hope today is a good one, Nancy Harris Bonk, Patient Leader/Moderator Migraine.com Team

I have been on Topamax 100 mg at night and 25 in the morning for about 5 years and have found it has worked. I've had some brain fog and some tingles in my fingers but very little. Has really cut down my migraines significantly.

Great questions. Have you experienced any side effects with the Topamax? It is known for causing brain fog in the initial months. I have been taking Topamax for many years at a dosage that started low and increased to 100mg. I wonder how long you've been on it? Most doctors suggest a trial period of at least 3-6 months. My colleagues have sent you good links about Topamax so do check those out. Amitriptyline I also tried but it didn't work for me and did cause weight gain. Have you tried any of the CGRP drugs? With your migraine attack frequency, it would make sense for you to be considered for those. You might ask your doctor about that option at your next appointment:https://migraine.com/cgrp-new-direction-migraine-treatment. Please let us know if you have any additional questions. Warmly- Holly -migraine.com team