How long do you stay on Topamax for migraines?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on June 20, 2025.

Official Answer by Drugs.com

Key Points

You can usually stay on Topamax (topiramate) to help prevent your migraine headaches as long as treatment is needed and remains safe for you.
You and your doctor will decide how long you stay on treatment. This will be based on how well it is working for you and any side effects you may experience.
You start treatment with lower doses and slowly increase over 4 weeks to help limit side effects.

Topamax is used for the preventive treatment of migraines in patients 12 years of age and older. It may not completely eliminate your migraine headaches.

Topamax is classified as an anticonvulsant (seizure) medication, but is prescribed for other conditions, too, such as migraine headache prevention.

Common side effects with Topamax when used for migraine prevention include:

paresthesia (unusual feeling of the skin, such as burning, numbness, tingling, or “pin-and-needles”)
anorexia (lack or loss of appetite)
weight loss
taste changes
diarrhea
difficulty with memory
hypoesthesia (a decrease in sensations such as the feeling of touch or temperature)
nausea

How long does it take Topamax to start working?

It may take 2 to 3 months for you to see the full effect of Topamax on your migraine headaches. In research studies, some patients had fewer headaches after one month of treatment.

Topamax for migraine prevention is usually started slowly at lower doses. Your doctor will slowly increase your dose over a 4 week period. The recommended daily dose of Topamax for migraine prevention is 50 mg twice a day (taken in the morning and evening).

Learn more: Topamax dosage (in more detail)

Topamax is available as oral tablets and as oral sprinkle capsules. Do not chew, break or crush the tablets as they have a bitter taste. The capsules can be swallowed whole or sprinkled on a small amount (a teaspoon) of soft food and consumed right away. Do not chew the food and medicine mixture.

How do I stop treatment with Topamax?

Do not stop taking Topamax without first talking to a healthcare provider. Stopping Topamax suddenly can cause serious problems. If you have epilepsy and you stop taking Topamax suddenly, you may have seizures that do not stop. You may also experience other serious withdrawal symptoms.

Your doctor will tell you how to stop taking Topamax slowly. This is usually done over a period of several weeks or longer.

Your doctor may also decide to change your dose. Do not change your dose without talking to your healthcare provider. Always take your Topamax exactly as prescribed by your doctor.

This is not all the information you need to know about Topamax (topiramate) for safe and effective use. Review the full Topamax information here, and discuss this and any questions you have with your doctor or other health care provider.

References

Topamax (topiramate). Prescribing information and Medication Guide. Janssen Pharmaceuticals. Titusville, NJ. Accessed June 30, 2021 at https://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/TOPAMAX-pi.pdf

How long does Topamax stay in your system?

Topamax stays in your system for approximately 4 to 5 days after the last dose, but this may vary depending on personal factors, such as your age, weight, dosage, and what other medications you currently take. This estimate is based on the half-life of Topamax which is about 21 hours and experts agree that it takes up to 5 half-lives for a drug without active metabolites to be completely removed from the body. A drug’s half-life is the time it takes for 50% of that drug to be removed from the body. Topamax does have some metabolites, but these are not considered active and only make up about 5% of an administered dose. This means it takes 84 to 105 hours for Topamax to leave your body. Continue reading

How does Trokendi XR help with weight loss?

Trokendi (topiramate) XR can lead to weight loss when used for prevention of migraine headaches or seizures, but it is not approved as a weight loss medicine. Loss of appetite and other digestive issues, which may contribute to weight loss, have been reported in topiramate studies. Continue reading

Are Topamax and Trokendi XR the same thing?

Topamax and Trokendi XR and are both approved by the FDA for seizure control in certain forms of epilepsy and for migraine headache prevention, but there are differences between these drugs, including approved ages for use, dosage forms, and dosing schedules. Continue reading

How long do you stay on Topamax for migraines?

Key Points

How long does it take Topamax to start working?

Related questions

How do I stop treatment with Topamax?

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How long does Topamax stay in your system?

How does Trokendi XR help with weight loss?

Are Topamax and Trokendi XR the same thing?

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