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Prevent Migraines and Pare Pounds?

Can you tell me the name of the new migraine maintenance drug that has weight loss as the only side effect?

Answer (Published 5/9/2003)

The prescription drug topiramate (Topamax®) helps reduce migraine headaches in more than 50 percent of patients who have tried it. One of the side effects of the drug is modest weight loss, about 3.8 percent of body weight.

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Topiramate is one of a new class of drugs called neuronal stabilizers, similar to the popular Neurontin® and is mainly used to treat epileptic seizures. However, results of a randomized, double-blind, placebo-controlled study found last year that it also decreases the frequency of migraines. While weight loss may be a welcome consequence of taking topiramate, the drug can also cause less desirable side effects. Some migraine patients experienced nausea and tingling of the extremities. Depression, fatigue, and nervousness were also reported with higher doses. Other potential side effects include abdominal pain and tremors, and even weight gain in a few people. Because topiramate can increase the risk of kidney stones, its use needs to be closely monitored in patients with kidney disease.

When this drug is prescribed for migraine prevention, physicians typically begin with a low dose of about 15 mg daily and raise the dose weekly to a maximum of 200 mg daily, a lower dose than given for seizures. (Doses as low as 50 mg can be effective in preventing migraines.) Topiramate is one of a number of prescription medications used to prevent the frequency and severity of migraines. Alternatively, you can try these non-drug measures:

  • Eliminate coffee, decaf and all sources of caffeine.
  • Eliminate chocolate, red wine (sometimes white wine, too), strong-flavored cheeses, fermented foods (like soy sauce and miso), sardines, anchovies, and pickled herring.
  • Learn to raise the temperature of your hands via biofeedback. This relaxation technique can help abort a headache at the start of an attack.

In addition, you can ask your doctor about taking high doses of vitamin B-2 (riboflavin). A recent Belgian study found that 400 milligrams of B-2 daily (you'll need a prescription for that amount, though it appears to be quite safe) reduced the frequency and duration of migraines.

Andrew Weil, M.D.

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