Thursday, December 15, 2011 Beth asks

Q: Has anyone noticed improvement in daily headache when switching from taking topamax all at night to two doses?

I take it all at night, and have no pain when I wake up but it worsens during the day.

P.S. I recently titrated up to 100 mg from 75 mg and finally felt no pain in the morning the day after titrating up to 100 mg at night. (Headache started 11/4/11 and persists almost 6 weeks later.) Pain can get to a 3/4 by 2 or 3 in the afternoon though. Just wondering if splitting the doses might help prevent the afternoon pain. I haven't split because I'm worried about side effects during the day. Thanks for advice!

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Answers (5)

Nancy Harris Bonk, Health Guide

12/16/11 3:24pm

Hi Beth,

According to the Migraine specialists we work with, it is very important that Topamax be started at a low dose and slowly titrated up to a split daily dose so the patient gets the maximum benefit. The starting dose may be 25 mgs once at bedtime for a week, then twice a day, 25mg. in the morning, 25mg at bedtime and so on. Typically potential side effects will lessen over time and it can take up to three months before we see a reduction in our Migraine frequency and severity.

To read the information on Topamax, continue on in our Topamax Profile.

Good luck

Nancy

Teri Robert, Health Guide

12/19/11 4:00pm

Beth,

To add to what Nancy said, both the recommendations we've had from Migraine specialists and the FDA approved prescribing information say to split the dosage. There are two main reasons for this:

1) The half-life of Topamax is only 21 hours, so splitting the total dosage into two daily doses keeps the level of Topamax in your system more level. This makes it more likely to be effective for you.

2) Topamax side effects have been found to be dose-dependent, which means that the tend to be more prevalent and bothersome at higher dosages. Splitting the dosage can help with that issue.

All of this said, we cannot tell you to change the instructions your doctor has given you. It's important to talk with your doctor before making any changes.

Teri

jnk

12/19/11 4:30pm

I have always split the dosage per my doctors orders and it has really been working well for me. If one dose is higher than the other, I take the higher dose at night as I tend to wake up with migraines for some reason...and that works for me. If you tend to get your migraines during the daytime or late afternoon, then I would suggest to take the higher dose in the morning. But the key to this drug is to always go up or down in 25mg increments and to do it slowly. Do not make any adjustments abruptly, as I am sure your doctor has told you.

Beth

12/20/11 11:17am

Thanks for your responses everybody. My doc did tell me yesterday that, by all means, I could/should divide the doses (I was resistant at first, several years ago). Today was my first day taking 50 mg in the morning. For the first hour I felt a little spacey and tired, but now I feel more alert. I'm really relieved at this because, in general, topamax has worked wonderfully for me. I think my headache is worse today because I'm premenstrual. Antother several days and I should be out of the woods! (Typically happens for me.)

WolfWidow

12/19/11 8:21pm

I am curious for those who ARE splitting their doses...do you find that it helps lower the side effects? I've been avoiding taking the topamax I was prescribed because of how badly it affects my sense of taste. I hate the migraines, but I also hate how the topamax really screws up my taste buds.

jnk

12/20/11 11:24am

I have not gotten that particular side effect, but I have had other side effects, in particular pins/needles in the legs. That went away after being on the Topamax for awhile, I guess the body gets used to it. I do think that splitting the dosage helps with the side effects as your not putting all that medication in your body at one time. Another thing that I found was the generic seemed to intensify my side effects more than the brand. But that could just be me. If you are just starting out on the Topa, I would say hang in there, if it helps the migraines, the taste bud thing could go away--GL!

Peggy H

12/22/11 12:53pm

I've always split the dose. Built up to 50 mg mornings and 50 mg evenings as soon as I could, and then have stayed at that level. I charted all of my migraines for a year before I started on the topomax and for the 3 years since. I was averaging 6-11 migraines a month pre-Topomax and am now down to 3.5 a month. It took almost a year for the Topomax to be effective, and I was almost ready to give up on it. So glad I stuck with it, and would not give it up now for anything. BTW, absolutely no side effects for me. However, my sister, a teacher, did not care for it at all for her migraines and quit it after a short while... called it 'dope-amax'.

Q: Has anyone noticed improvement in daily headache when switching from taking topamax all at night to two doses?

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