Topiramate + Nortriptyline (and another reason why treatment is not simple)

We’ve talked about nortriptyline, an antidepressant commonly prescribed for chronic pain, and topiramate, an anticonvulsant often used for migraine in particular, in the past. As you can see from the comments people leave here, both have been a wonderful help – or haven’t been so great – depending on the patient.

It’s not unusual for someone to try one or the other, discover that they’re still having migraine attacks, and drop the medication permanently. But that may not always be the best option.

A study published in the Journal of Headache and Pain in 2010 tested both of these medications together as a migraine treatment.

Researchers started with patients that had experienced less than 50% reduction in symptoms with either topiramate (Topamax) or nortriptyline after trying either one for eight weeks. 78.3% of the patients improved more when taking both together than when taking just one.

It is not unusual for a combination of treatments to be better – sometimes drastically better – than one or the other. This is just another example.

When your doctor suggests you retry something you’ve already tried – but this time with something else, whether it be a supplement or drug or other type of treatment, don’t brush the idea aside quickly (even if the drug didn’t work in the past at all).

On the other hand, be very cautious if you have experienced significant side effects in the past. For example, when it comes to topiramate watch out for heart palpitations or chest pain, visual changes, weakness, confusion, or a loss of appetite. For nortriptyline, common things to watch for are depression, trouble breathing, seizures, fever, fatigue or weakness.

And remember, never change your dosage without checking with your doctor.

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