Verapamil vs. topamax

Hi all,
I am due to start verapamil. I have heard a lot of people say it helps them with their vertigo. Here’s my question, are we talking vertigo or dizziness here? I get both but my main problem is constant dizziness with true vertigo being a factor only in certain head positions. Or upon first getting out of bed in the morning.
So has anyone had luck with verapamil and general dizziness? I can’t say for sure how it will affect me and I know the only way to know for sure is to try it, but still I’m wondering about success rates.

Also, I was going to try the topamax first but again, I’ve only heard about that drug working for migraine head pain and not the dizziness type of migraine. Any thoughts to the contrary?


Personally for me Xanex helps to keep me more stationary with less rocking/motion and also keeps the Vertigo at bay. The Verapamil decreases the Tension build-up inside my head.



I used to throw questions like this out to the forum all the time when first trialing a new drug. I would do a search using the name of my new drug and came up with a variety of what it helped, made worse, or had no effect on. My first doctor claimed that “this drug is for such and such, that drug is for this and that.” I got so confused, because what he was telling me was not in synch with what i was reading on this forum, so i emailed Hain. He told me, “my understanding is that if you stop the migraine, you stop the symptoms.”

Now that I’m a patient of his, i can add a little more to that aphorism. Stopping the migraine may take more than one drug. Topamax has done a great deal for me at 100mg. I may have to go up on that dose, but he’s a conservative prescriber and does not want to bring on cognitive SEs. so he opted for low dose Effexor first. If that doesn’t wipe out the rest of the migraine with low dose Effexor (and he doesn’t like to go high on that because of the dreaded Effexor withdrawal) he will likely either go up further on the Effexor or on the Topamax. And if that doesn’t work he will add a TCA.

But his thinking is not that one drug is good for a particular symptom, it’s that one drug has brought your threshold down and taken care of some of your symptoms (and that part may be individual) - make sense?


HT, personally, I’d say give the verapamil a try first. It works faster, and it’s easier to get off of if it doesn’t work. Then, If it doesn’t work, try the Topamax. The Topamax DOES work for the dizziness btw. It worked for me. I remember driving 3 months ago, and coming to a traffic light, and the dizziness would overwhelm me. Now, it’s just a slight movement of everything at a stop light. Still, sadly, I’m coming off the topamax. I can’t breathe on it. A little not-so-common info about topamax, it can cause breathing problems in asthma patients, as well as people who are just susceptible. I had breathing issues from the time I got up to a full tab of it, but I was hoping it would go away. It didn’t. And now I have to deal with not being able to breathe on this entire titration down as well. I have to titrate down the same way I went up, so that’s 3 more months of no breathing!!! Don’t be afraid though. If you are going to get this symptom, it usually happens early in treatment, and at that point, you can just stop the drug. I pushed through, and thought it would just go away. Now my chest is always tight, I’m always coughing up “stuff”, and I’m out of breath doing every little thing. But on a positive note, I have almost no headaches, and I have absolutely NO swings in MAV symptoms unless I do intense manual labor for several hours a day. And that’s just on one medication, at under 75mg. So the topamax CAN work. If it weren’t for the breathing issue, I’d be shooting for the stars with this drug. But it’s absolutely destroying my lungs, and drying me out. I’m going to be doing effexor, verapamil, and klonopin to make up for the loss here. It stinks, but breathing is NOT over-rated. Good luck to you!


half there. you said

Also, I was going to try the topamax first but again, I’ve only heard about that drug working for migraine head pain and not the dizziness type of migraine. Any thoughts to the contrary?Halfthere

I suppose its time to come out of the closet.
I’ve been on topamax for a few months now, and my migraines have almost stopped! At only 75mg,
This is the first time in 15 years I’ve had peace of mind, my rocking also stopped 4 days ago :mrgreen:
I was waiting for a while before I posted my good news,
Because I didn’t want to jump the gate incase the topa stopped working and I had given you all false hope.
It’s just the beginning for me, and anything can happen.

topamax has stopped most things for me, I can on occasions when I turn my head too quickly still feel a sense of motion intolerance but it leave’s as soon as the head truing is over and doesn’t linger “at all”
I only experience this late in the afternoons or when I become over tired.

I’ve never experienced quick spinning vertigo like some of you other MAVers here so I can’t relate my symptoms to your vertigo.
Dizziness to me is a completely different word to what “I have experienced” over the last 15 years of my MAV.
I ROCK 24/7 not spin.
Like on a boat sitting in a windy harbor.
Sometimes being pushed and pulled from front to side, like G forces.

I love my topa.

— Begin quote from "jennyd"

— End quote

— Begin quote from ____

I suppose its time to come out of the closet.

— End quote


— Begin quote from ____

I’ve been on topamax for a few months now, and my migraines have almost stopped! At only 75mg,
This is the first time in 15 years I’ve had peace of mind, my rocking also stopped 4 days ago :mrgreen:

I love my topa.

— End quote


You’ve been on a very long boat ride, Jen. It’s time to come home. :cry: (tears of JOY)

fingers and toes crossed (i’ll watch my dreams for any boats named “Jenny”)


Congratuations Jen, it gives us all hope to hear that you are doing so well. Long may it continue!


I wonder if any of you know what your posts did for my emotional well being. In a world where hope is all we have, it did a lot :mrgreen:

I will go forward and start the verapamil (was suppose to start on Friday, but pharmacy screwed up my prescription info) and now I can bravely face the topamax if need be.

Congratulations Jenny, I am SO happy for you! Here’s to a normal functioning brain! :wink:

In my case the episodic vertigo stopped within 3 weeks of the time that I started on Verapamil. The “lightheadedness” however still comes and goes. Its annoying but not debilitating and I’m pretty much doing everything that I was doing prior to this mess. Everyone is different though. There is enough evidence that people improve with Verapamil that I’d definitely give it a try. In general the chance of serious side effects with it is pretty low - especially at dosages lower than about 240 mg/day. I’m currently at 120 mg/day. What dose are they talking about starting you out at?


Hello Half there and chaz, yes I totally agree about the verapamil, if you remember it was the first drug i got to try and it was very easy on the system and made a world of difference to my mav.
Motion intolerance was better and migraines less frequent, unfortunately just as intense when they happened
, But that’s just in my case.
EVERY Body’s different.

Thanks, Becky chaz julie and halfthere for your well wishes,
They are much appreciated, and yes there is hope after all,
I never thought I’d be one of those people saying that.
((((hugs))))) :smiley:

The Dr. wants to start me at 180 mg. is that too high for the first dose? What has everyone else been started at?

Half there I was put on that first up,
and had no problems, a few small headaches for the first 3 days nothing else.

I started and remained at 120mg of Verapamil at night. No problems. My only side effect was the need for a little extra fiber in my diet, if you know what I mean. :oops: If you’re worried about starting at 180mg, you could always start lower and then go up when you feel confortable with it.

anybody know the chances that it will lower blood pressure/pulse enough to cause significant fatigue or problems in someone with already low vitals? I have sinus bradycardia (low pulse while sleeping, under 50 beats per minute) and my pulse is routinely 55 beats per minute when laying down, which an average pulse of 66 beats per minute. My BP is typically 110/55 at it’s lowest. I ask because this is the next med for me. Topamax has been fantastic at stopping the swings in MAV symptoms, it has COMPLETELY stopped the rocking, swaying, and trampoline feeling when walking, but it has induced asthma (i’m not the only person this happened to!) as per a breathing test I did today and I can’t deal with that. I lost 25% of my lung capacity on this med. Again, I LOVE it for my MAV symptoms but my lungs hate it. I also have developed a persistent dry cough that won’t stop. It’s an infection waiting to happen. It’s a shame. This drug was going to be the drug for me. But I couldn’t get any higher than 60mg or so. Now I’m back down to 50mg and continuing to taper. I’m hoping the verapamil will fill in the gaps. And it’s safe for asthama patients. I just don’t think it will do the job topamax did by itself. What a shame


Most people tolerate 180 mg/day of Verapamil (or even higher) very well. If your BP is marginally low however, this could be a concern. In my case I started to see some occassional mild postural hypotension and dizziness at 180 mg/day. This was a completely new set of symtoms for me - heart racing and mild dizziness for about a minute after standing up from a lying position. This occurs in some people because the Verapamil forces the blood vessels to dialate. On the one hand this facilitates good blood flow to the brain/ear/eye/etc and often eliminates the neurological symptoms of migraine. On the other hand the blood vessels can’t contract like they are supposed to when you stand up suddenly - the blood pressure drops in your head and this can cause transient dizziness. Then your heart beats like crazy for 30 seconds as it tries to restore blood pressure to your head. This is actually a fairly rare side effect, but lucky me, I developed it. The good news is that I dropped back to 120 and this seems to be the magic dose for me. Keeps the MAV symptoms under control about as well as 180 and the “postural” side effects seem to be gone at this dose.

Just to emphasize though - most people have few signifcant side effects even at high dosages. We actually chose this medication for me largely because, if I can ever get this mess under good control, I hope to get my FAA medical back and go back to a flying job. Very few of the drugs that are used for migraine prevention are FAA certifiable, but Verapamil is an exception. The FAA is very conservative about what drugs it will allow when considering pilot certifaction issues, so you know Verapamil is pretty benign.


Thanks you, it’s good to know all this. I started the verapamil at 90 mg for the last two nights and had no problems other than being pretty tired and ready for sleep a couple hours after taking it, but I think I’ll give the 180 mg a try tonight. I discovered I need to take it pretty early in the evening so I don’t wake as groggy. I wish I had some 120 pills, I suspect that might be enough for me but we’ll see. One interesting and amazing thing is that as well as feeling tired a couple hours after taking it, I also felt symptom free. I thought it was a fluke until it happend again the 2nd night. Of course, it didn’t last. I still wake up fuzzy headed but that is another reason why I’m curious about upping the dose to see if more in my system will last longer.
Did anyone else feel good so soon after taking it? I’m going to take this as a positive sign. I’m keeping my fingers crossed that it will begin working that way for me full time. :slight_smile: Wish me luck!

Hi Bos, I Had coughing and chest complaints for a long time after trying topa, until they lowerd my verapamil from 240mg to 180mg and now my chest is clearing up so maybe it wasnt the topamax at all.
hmmmmmm… :idea:



is hain considering giving you verapamil with a resting heart rate of 55?