Starting topamax (topiramate) for migrane soon, neurologist wants me to start at 25mg twice a day for a week then go up to 50mg twice a day. is this too fast?

Not necessarily: The neurologist is an expert in migraine. He or she will certainly know how to safely prescribe and use this drug. However, you must report back to the neurologist if you have any unusual or adverse effects. It is this feedback which may change the way the drug is prescribed. Then of course there must be a follow-up visit to reevaluate the treatment.

Not too fast: It all depends on how you tolerate the medication. Topamax (topiramate) can sometimes cause tingling in fingertips. Strawberries or vitamin c can help (i am told). Just start on the initial dose and increase it slowly. Don't feel pressured to go up too fast. That is when bad side effects will happen.

This is fast: This is an aggressive titration, hoping that you can "gut it out" through the initial tingling in your fingers & toes, forgetfulness, loss of appetite, and empty-headed feeling, so you can get headache relief sooner. It is a fast rise in dose, but it's a strategy we sometimes use.