Most medications in use for Migraine prevention have a number of side effects, and many, if not most, migraineurs are sensitive to medications and their side effects. Topamax, which I am currently using, is used successfully by many and considered to have intolerable side effects by others. Some months ago I read Teri Robert's report on Dr. Stephen Silberstein's (of the Jefferson Headache Center) recommendations for a gradual increase (titration) schedule on My Migraine Connection. You can read Dr. Silberstein's Topamax Recommendations here, regarding how to slowly increase the dosage. He observed that "proper dosage and titration (tapering up the dosage) is essential for successful use of Topamax."
Being naturally rather suspicious of medications, I went into my headache specialist with this information, and asked that we titrate slowly. I was pleased to discover that Dr. Gerhardstein takes an even more cautious approach than I do. At this point I have been on the minimum dosage for about a month. I saw Dr. G in New Brunswick again this week and he wants me to have an eye exam to rule out glaucoma before increasing the dosage. I have that scheduled for next week. Assuming that exam result is okay (no reason to think it won't be), I will go to 50 mg daily after that.
I asked Dr. G about instituting an increase schedule after that point and he told me he doesn't want to go on a regular weekly or bi-weekly increase schedule because it is easy to "blow right past" the minimum effective dose that way. He said he thinks many incidents of intolerable side effects may be from being on too high a dosage. The plan is for me to try each increased dosage for about 3-4 weeks and then call him to discuss. He wants me to keep a detailed diary and stay very aware of my body's reactions.
I really like this approach. I know we are all impatient for results, no one wants to stay in pain and with the disruptions of frequent Migraines. But I think this way I can minimize side effects and have the most control and awareness over what is happening in my body. If more side effects are experienced on higher dosages, and we could end up on a higher dosage than we need by not giving each level a long enough try, maybe a very slow titration increases our chance of finding the level that is optimum for each of us, with the best balance of Migraine prevention to side effects. In the meantime, we can be listening carefully to our bodies and observing their reactions.
Ocean daybreak image courtesy of Hideyuki Kamon.
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