Topiramate and valproate are seizure medicines that are typically used to control seizures in people who have epilepsy. It is not clear how they work to prevent migraines.
Why It Is Used
These seizure medicines, when they are taken regularly, may help to prevent migraine headaches.
How Well It Works
These medicines can reduce the number of migraines you get each month by more than half. This happened to about 50 out of 100 people who took these medicines to prevent migraines.footnote 1
Common side effects of topiramate include:
A prickling or tingling sensation in the hands and feet.
Lack of coordination.
Loss of appetite and weight loss.
Inability to concentrate or speak clearly.
Topiramate has been linked in some people to a potentially life-threatening condition called metabolic acidosis, which happens when there is too much acid in the blood. Symptoms include fatigue, lack of appetite, and rapid breathing (hyperventilation). If left untreated, metabolic acidosis can lead to death.
In rare cases, topiramate may cause serious side effects, such as:
Headache pain that is different than pain from a migraine headache.
Uncommon but potentially life-threatening side effects of valproate include:
Inflammation of the pancreas.
Elevated levels of ammonia in the blood (hyperammonemia).
The U.S. Food and Drug Administration (FDA) has issued a warning on seizure medicines and the risk of suicide and suicidal thoughts. The FDA does not recommend that people stop using these medicines. Instead, people who take seizure medicines should be watched closely for warning signs of suicide. People who take seizure medicines and who are worried about this side effect should talk to a doctor.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Do not use valproate if you are pregnant, breast-feeding, or planning to get pregnant. If you need to use this medicine, talk to your doctor about how you can prevent pregnancy.
Women who use topiramate during pregnancy have a slightly higher chance of having a baby with birth defects. If you are pregnant or planning to get pregnant, you and your doctor must weigh the risks of using this medicine against the risks of not treating your condition.
Topiramate may make birth control pills less effective. A woman who is taking topiramate may need to use another method of birth control to reduce her chances of becoming pregnant.
If you have had kidney stones, be sure to tell your doctor this before you take topiramate. Using topiramate may increase your risk of having kidney stones again.
Drugs for migraine (2013). Treatment Guidelines From The Medical Letter, 11(136): 107–112.
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