Clinical Assessment of Topamax in Patients With MAV

Hi All,

Finally a study directed at MAV using Topamax:

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Objective. To assess the efficacy of topiramate in reducing both the frequency and the severity of vertigo and headache attacks in patients with migrainous vertigo and to compare 50 and 100 mg/day doses of the drug.

Methods. Thirty patients diagnosed as definite migrainous vertigo were recruited in the study. Vertigo and headache frequency was determined as the monthly number of attacks whereas severity was determined by visual analog scales measured in millimeters from 0 to 100. Patients were randomised to either 50 or 100 mg/day topiramate for 6 months. Vertigo and headache frequency and severity were evaluated at the end of the study period.

Results. Number of mothly vertigo attacks decreased significantly in the overall group after treatment (median from 5.5 to 1; P < 0.01). The same was true for monthly headache attacks (median from 4 to 1; P < 0.01). A statically significant improvement in vertigo severity was noted (median from 80 to 20 mm; P < 0.01). Headache severity showed significant improvement as well (median from 60 to 30 mm; P < 0.01). No statistically significant difference between high- and low-dose groups was present regarding efficacy (P > 0.05). Four patients in the high-dose group discontinued treatment at the end of the first month because of adverse effects.

Conclusions. In the overall group, topiramate was found to be effective in reducing the frequency and the severity of vertigo and headache attacks. Both doses of the drug were equally efficacious. The 50 mg/day dose seems to be appropriate as higher adverse effects were noted when 100 mg/day was used.

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edit: haven’t had a chance to read this through but will tomorrow. At first glance it looks like there were dropouts.

Scott 8)

Scott, another great find! Interesting that 50 mg versus 100 mg didn’t seen to show much difference. I hope that I can eventually get up to 50 mg and stay there for a bit and see if it helps some. Thanks again. Ben

Hey Scott,
Thanks for posting this paper. I actually just quickly read through it. (I tried to post it, but I keep getting the message The extension pdf is not allowed)… Am I doing something wrong?

In any event, the only thing that makes me uncomfortable about the results of this paper are the adverse effects reported and discontinuation rate. I will be curious what others think.

I hope today brings you a better day. I can’t believe you have to do so much (and actually do it) with all you are going through. You are so strong.


Thanks for posting that, especially in view of not feeling well. I wonder – Is there are way to contact the authors via email. I just wonder about the adverse effects too, as well as their thoughts on people with chronic vertigo/dizziness, rather than episodes.

Hi Lisa and all,

Just posted the full paper. Lisa, you’ll probably have to Google these guys for an email address. The work was done in Turkey!

Bedtime for me … finally home!

Not a single male patient in the trial. :? Kind of screws the results up… Who knows what differences there may be?

I THINK, Generally men are less prone to sideffects than women. Migraine seems to cancel that difference quite a bit though…

Good night sleep tight scott. Hope you feel better tomorrow :]

ps. Is it the verapamil causing this for you?

Well, you all know I use 50 mg of topamax to control my MAV VERY nicely and I have NO side-effects. I mean ZERO. I had some increased dizziness and some diarrhea when I first titrated up and, when I went too high, I couldn’t breathe well (induced asthma) but when I lowered back to 50 mg, it was like a miracle. I think the problem with Topamax is it’s not necessarily the drug, but the SCHEDULE. 25mg to start off with is a MONSTER amount. I started at 6.25 mg because 12.5 mg destroyed me! I reacted even at the 6.25 mg. Most of us are very med senstive to begin with, and I imagine that most of the drop outs were med sensitive too, and had they gone on it with a slower titration, they probably would have tolerated the med. I’d like to see a study on a slower titration. No doubt the drug works like gangbusters!


Hi Rich,
You make a great point about the titration schedule. With all studies, you have to read the methods section very carefully. MAV patients are a different breed. I have prescribed all of these drugs to non-MAV patients and would think nothing for example of starting a patient on 50 mg of Zoloft right away…moving them up to a higher dose pretty quickly if needed. Non-MAV patients have no problem at these levels as they are still very low. 25 mg of Topamax is a low starting dose for non-MAV patients, etc as well, and would be easily tolerated by non-MAV patients. As with all the scientific literature, it must be read very carefully.
I’m glad you are still doing well and contributing to the forum.

Great point, Rich!! unfortunately, these studies are limited in terms of good research design.

Could we get this moved to the Science & Research section so we can find it later?


Hi Lisa and Brenda,

I missed your post in the other thread this week. Here’s the study you were asking for.

Best … Scott

Another thing I notice is that the study says that it decreases the frequency and severity of migraine attacks and dizzines. My MAV is 24/7, this study does not seem to include that type of situation.

When I was on Topamax, I experienced more visual auras and noticed only a marginal decrease in dizziness in the 4 weeks that I took it.

Man, there are two side effects that keep me from using this med. When I took it, there was a definte improvement in my dizzyness, my 18 non-stop dizzy spell finally went away, the frequency of my dizzyspells drastically decreased, and my falling stopped within three days completely, the whole time I was on the med, both times.

My problem with it is that it gave me one constant nasty headache, that did not go away until I had been off of it for a while. No rest from it, woke up with it, went to bed with it. The other side effect was extreme temper. If I would have stayed on it, I would have ended up in prison under manslaughter charges of sometype.

If I had been on this test, I would have skewed the data with my constant non-stop headache. :lol: