Topiramate is an anticonvulsant agent effective in the prophylaxis of migraine, 
which also induces weight reduction by an unknown mechanism. We investigated the 
effect of topiramate on metabolic and endocrine parameters in patients with 
migraine independently of any intention to lose body weight. Six patients (26-61 
years old, body mass indices [BMI] 20.9-32.1 kg/m(2)) with migraine were treated 
with an average dose of 100 mg topiramate/day over a period of 20 weeks. The 
following parameters were measured every 4-8 weeks: BMI, body fat proportion, 
waist and hip circumference, HOMA insulin resistance, fasting serum-/plasma 
concentrations of adiponectin, leptin, ghrelin, vascular endothelial growth 
factor (VEGF), cortisol, interleukin-6 and tumor necrosis factor (TNF)-alpha. 
Profound metabolic changes were observed for the whole treatment period. 
Compared with the baseline value, 20 weeks of treatment reduced the BMI by 
7.2+/-1.4%, body fat proportion by 11.6+/-3.6%, waist circumference by 
4.2+/-1.2%, leptin by 39.2+/-6.5% and HOMA insulin resistance by 37.3+/-5%, 
while adiponectin was increased by 69.9+/-17.3% (P<0.05, respectively). VEGF 
concentrations increased during the week 2-4 by 177.4+/-39.4% (P<0.05) followed 
by a continuous decrease. There were trends for a reduction in ghrelin 
concentration, whereas cortisol, interleukin-6 and TNF-alpha values were 
unchanged. In summary, in this small sample of migraine patients topiramate 
treatment was associated with increased insulin sensitivity, increased 
adiponectin concentration and a reduction of body fat in all treated patients. 
The role of increased VEGF concentrations prior to these metabolic changes is 
not clear and might, hypothetically, involve a centrally mediated effect of 
topiramate on body weight regulation.