Which med is worse as far as tolerability and side effects? Topiramate or Nortriptyline?

Hi everyone, I am still trying to wean off of sertraline, which is not a fun experience. I have 2 neurotologists suggesting different meds. One says Nort the other says topiramate. The one that suggests Nort says that topiramate is very hard to tolerate. I am at a loss right now. If anyone has any input that would be great. I know these meds are different for everyone but usually several people’s experiences line up pretty well with the side effects etc. I wish there was a medication that could treat this that wasn’t so scary. Thanks in advance.

I just started meds again and before choosing which one to go with I wanted to weigh the pros and cons on a few different meds. Here is what I came up with for Topamax and Nortriptyline. I was on Amitriptyline starting in October 2018 and was on it for about a year total. It worked well, not 100%, but pretty darn good.

+Have read many success stories from topamax (13% on med poll said topamax was helpful)
+Weight loss
+Dr. Hain says “small doses usually side effect free”
-Side effects can be hard- cognitive, known as “dopamax”

+Also many success stories from nortriptyline (21% on med poll said nortriptyline was helpful)
+Dr. Rauch’s favorite according to the survival guide on this site
+Usually better tolerated than Ami (I had a tough time getting on ami)
-Potential side effect of weight gain

So, that being said I tried topamax starting at 15mg (child’s beginning dose) and did well for a few days, but on my 5th dose I had a really strange attack when falling asleep. I gave it a few more days and the attacks continued to happen. I decided to stop topamax and started nortriptyline. I have been on nortriptyline for almost 5 weeks now and am taking 20mg. It has been easy, breezy for me to get on, and like I mentioned I had a horrible time getting on Amitriptyline (I felt like I was in a cloud and had very severe depression, but that all went away after about 7 weeks and then the amitriptyline worked well).

Like you said everyone will have different experiences with meds and you won’t know until you try! Good luck!

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From all I have read and that’s a huge amount over a long period I would say Topiramate hands down. I have no personal experience of either and as you say it’s very much individual experience. Topiramate is one of the three recommended as first line by UK NHS for effectiveness but many find it intolerable. Many more I suspect than find Nortriptyline so. Can I suggest you Search ‘Grampian’ health guidelines on this site. Sorry due to my current ultra slow broadband speed I can’t currently offer you a link.

I don’t really think it’s a case of scary drugs. They are safe and established and understood by doctors. Our problem is MAV increases sensitivity to all manner of things from caffeine, chocolate and cheese to stripey patterns, sunlight and medications. Medication sensitivity is just another one. Lots of MAVers have some of these sensitivities all their lives. I was sensitive to the above foods and medication from childhood long before MAV struck. No idea of your history and needing to bear in mind your doctor is responsible for your well being so may refuse suggestions made it might be worth discussing a beta blocker. Propranolol is another of the NHS chosen three first line preventatives.


Hi, can I ask why you went off of Ami? I started Ami almost 2 years ago and have gained 50lbs. I am wearing myself off now b/c if that. But it does work well, however I still have vertigo constantly depending on head movement.

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Aaah, it’s so tough to decide what to do regarding meds. We worry so much about tolerability and side effects when really the most important factor is how they will work on our symptoms. From my fairly wide reading (and personal experience), there is not a terribly consistent pattern, and with migraine drugs it is a trial and error world, sometimes involving combining drugs.

My experience may not be typical. Many people have great results with nortryptyline with few side effects. I had few side effects, but had only moderate results. I found it worked pretty well for headaches but only moderately for the dizziness/swimmy head symptoms. So after about 8 months I decided I wanted to change to something else.

I’ve tolerated topiramate fine (100mg), no troublesome side effects that I can identify. I should mention that I added topiramate to a drug regimen that now also includes venlafaxine and Aimovig. This is the combination that has seemed to bring a fairly good degree of symptom relief. The venlafaxine is for me the one that is most key at the moment, I realized last week when I had to go without for a few days due to a Covid-induced shortage.

Unfortunately, one has to just dive in when it comes to new meds, and see how it goes. From a therapeutic perspective, one could reasonably say that nortryptyline is a more conservative treatment option and a hence a more sensible route. However, it is also a similar class of drug as sertraline, so I can also see the logic of a doctor recommending a different class of drug (a heavier drug, one could say) as a next sequential step.

Experience with these drugs is so idiosyncratic; I wish there was more I could say to help. Except—any step you are taking is a step forward, know that. Take it with confidence and know that even if it is not the right drug for you, it is just another step toward healing and health. No need for fear. Wishing you luck.


Whow, that’s some shopping list. Just goes to show what a hard nut MAV can be to crack!

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