CNS Drugs

, Volume 29, Issue 2, pp 163–169 | Cite as

Weight Regain after Discontinuation of Topiramate Treatment in Patients with Migraine: a Prospective Observational Study

  • Alberto Verrotti
  • Pasquale Parisi
  • Sergio Agostinelli
  • Giulia Loiacono
  • Francesca Marra
  • Giangennaro Coppola
  • Laura Rosa Pisani
  • Gaetano Gorgone
  • Pasquale Striano
  • Francesco Pisani
  • Vincenzo Belcastro
Short Communication



To monitor weight regain after therapy discontinuation in patients with migraine experiencing weight loss during topiramate (TPM) treatment.


Patients with migraine without aura were enrolled in this observational prospective study. Weight, body mass index (BMI), waist circumference, systolic and diastolic blood pressure, plasma levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, leptin, and ghrelin, and homeostatic model assessment of insulin resistance (HOMA-IR) were evaluated before starting TPM (T1), at 3 (T2) and 6 (T3) months of treatment and 6 months after withdrawal of TPM (T4). Weight loss/regain was considered as a change of </>5 % of pre-TPM body weight.


A total of 241 patients were analyzed. Of these, 87 (36 %) patients experienced weight loss on TPM medication. During TPM therapy significant reductions in mean values of weight (p < 0.001), BMI (p < 0.001), waist circumference (p < 0.01), HOMA-IR (p < 0.01), and leptin (p < 0.01) were observed. After TPM discontinuation, all of these parameters showed a clear trend to increase at T4, achieving pre-TPM values in 27 patients. Among potential predictors, only HOMA-IR before starting TPM (parameter estimate = 1.36, effect size = 0.75; p = 0.006) was significantly associated with weight regain after therapy discontinuation.


Loss of body weight is a reversible effect, which at 6 months after TPM discontinuation shows a clear trend to return to baseline values. HOMA-IR is the only predictive factor of weight regain.



Alberto Verrotti, Pasquale Parisi, Sergio Agostinelli, Giulia Loiacono, Francesca Marra, Giangennaro Coppola, Laura Rosa Pisani, Gaetano Gorgone, Pasquale Striano, Francesco Pisani, and Vincenzo Belcastro have nothing to disclose and report no conflicts of interest. This manuscript received no funding.


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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Alberto Verrotti
    • 1
  • Pasquale Parisi
    • 2
  • Sergio Agostinelli
    • 3
  • Giulia Loiacono
    • 4
  • Francesca Marra
    • 2
  • Giangennaro Coppola
    • 5
  • Laura Rosa Pisani
    • 6
  • Gaetano Gorgone
    • 7
  • Pasquale Striano
    • 8
  • Francesco Pisani
    • 9
  • Vincenzo Belcastro
    • 10
  1. 1.Department of PediatricsUniversity of PerugiaPerugiaItaly
  2. 2.Child Neurology and Pediatric Headache Center, Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology c/o ‘S. Andrea’ HospitalUniversity of Rome ‘Sapienza’RomeItaly
  3. 3.Pediatric UnitOspedale Madonna del SoccorsoSan Benedetto del TrontoItaly
  4. 4.Department of PediatricsUniversity of ChietiChietiItaly
  5. 5.Child and Adolescent Neuropsychiatry, Medical SchoolUniversity of SalernoSalernoItaly
  6. 6.IRCCS Centro Neurolesi ‘Bonino-Pulejo’MessinaItaly
  7. 7.Neurology UnitTreviglio-Caravaggio HospitalTreviglioItaly
  8. 8.Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health‘G. Gaslini’ Institute, University of GenoaGenoaItaly
  9. 9.Department of NeurosciencesUniversity Hospital of MessinaMessinaItaly
  10. 10.Neurology Unit, Department of MedicineS. Anna HospitalComoItaly

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