Topamax not working? Here’s a Possible Alternative

Although Topamax (topiramate) has helped many patients, it is by no means the silver bullet to stop migraine.  It’s popularity has also been hampered by the side effects that some patients experience.

Of course there are many good alternatives to Topamax, but researchers are looking for something similar that will work for patients that are good candidates for something like topiramate, but who do not respond well to topiramate itself.

Zonegran - zonisamide

A study published in July (2014) investigated a drug called zonisamide as an alternative to topiramate.  In this case, patients with episodic migraine with aura were studied.  These were not patients who had severe reactions to topiramate, but who simply had not seen more than a 50% reduction of migraine attacks.

Zonisamide (sold as Zonegran)is another antiseizure drug.  Like Topamax, side effects are a common reason why patients do not continue with the treatment.  In fact, in this study 12% dropped out because of side effects such as dizziness, nausea, insomnia, and drowsiness.

In the end, however, there were two positive results.

First, many of the patients had much better success with zonisamide.  Over three months, every month things got better.

Second, side effects did actually seem to be less of a problem with zonisamide.  In particular, paresthesia (a tingling or burning feeling of the skin), one of the most common side effects in topiramate, was almost non-existent.

This is only a preliminary study.  It was open label (meaning the patients knew what they were taking), and patients directly switched to a steady dose of zonisamide (100mg/day taken in two doses).  It will be interesting to see how patients respond to different doses.

One other interesting note – some patients dropped out because they improved very quickly and decided they didn’t need more treatment!  That sounds great, although it’s too bad they didn’t understand the value of continuing the study so that the results can be measured.

Zonisamide has not been approved as a migraine medication, but this study shows that it is worth studying as an alternative preventative to Topamax.  If you’ve tried it, leave a comment and let us know how it worked for you.

Efficacy of Zonisamide in Migraineurs with Nonresponse to Topiramate
Zonegran (

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4 comments… add one
  • Jill Aug 23, 2014

    I have taken zonisamide for over 2 years and the results have been great! I used to take topiramate but couldn’t tolerate the side effects. Not so with zonisamide. I haven’t been bothered with any side effects to speak of, and that makes me very happy as it’s controlling my migraines very well. I take 400 mg (200 twice daily) and I’ve seen much improvement in my migraines. From what I’m told, I am actually on a lower – end dose and can increase if ever the need arises.

  • Cindy Jul 31, 2016

    I’ve been on Topamax for a long time and am looking to switch meds. The memory and insomnia side effects are too much! I think I’ve tried Zonegran. Does it contain Sulfa?

  • Jill Aug 2, 2016

    I’m not sure if Zonegran contains sulfa or not. I’m sure you could research it or ask your pharmacist. I no longer take Zonegran. I had to discontinue it because it was affecting my kidneys. I am now taking Namenda XR, Neurontin, and magnesium supplements. This combo is working very well for me now.

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