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Topamax dosage routine, other off label preventatives

If u dont mind, what’s the routine for most of you for Topomax dosage? Once nightly? Or twice daily? My neurologist has me on once nightly, only 75mg, but I still have 5-8 miserable migraine days per month. She also told me I could increase/decrease as needed, but gave no real guidelines, and now she quit practicing to go back to school. I don’t feel dopey like rumors I’ve heard, but can’t afford that in my technical job. I have the Heal Your Headache book and have followed those spartan, extreme diet restrictions for a few years now though I’m not sure with how much benefit. Not sure of the other preventive meds Buchholz mentions, some say they may drop BP……my blood pressure runs pretty low normally and an RX my urologist tried out on me made me pass out repeatedly, injuring myself. Antidepressants, well, maybe I could use a touch of those naturally, but scares me…I had heard in the past that coming off of them or missing doses could cause suicidal thoughts.!?!

  1. Hi, filbetter, thank you for reaching out! I hear how confusing it feels not being given guidelines from your doctor about how best to use your Topamax prescription. While we cannot offer medical advice over the internet (for your safety!), I thought you might find the forum discussion about Topamax to be of interest in providing perspectives from others who also use this medication.
    https://migraine.com/topic/topamax/
    As far as antidepressants are concerned, all bodies are unique and respond differently to treatments. Additionally, each medication is unique, and some have more side effects with missed doses than others. To my knowledge, all antidepressants are both started slowly, building up to the target dosage over time and are weaned back slowly when coming off them to avoid serious side effects and complications. This article gives an overview of the antidepressants most commonly prescribed as a treatment for migraine, though many others exist for the treatment of depression and other mental health/mood disorders. https://migraine.com/migraine-treatment/antidepressants-for-migraine-headaches/
    I would encourage that you seek to re-establish care with a new provider and discuss these questions with her/him. Having a physician who knows your symptoms and who prescribes and monitors your medications is essential when managing migraine. Please keep us posted on what you learn and how you are progressing with your treatment. Wishing you a gentle day. ~Allyson (Migraine.com team)

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