The Drug My Doctor Prescribed For My Migraines Also Causes Weight Loss and The Idea Is Making Me Anxious

I feel certain that my doctor did not prescribe me Topamax for its possible weight loss side effects, but that small mention stuck with me as the hardest to process, because it comes with the most baggage.
Publish date:
March 13, 2014
weight loss, fat, doctors, migraines

The familiar thin paper that wraps the benches of doctor's offices everywhere crunches under me as I swing my body upward and plunk my bum cheeks on the table, an action that immediately triggers a number of thoughts, worries or irrational fears from past experiences. Memories of every other doctor's visit I'd ever made enter my mind, rushing in like I'd opened the flood gates, my blood pressure spiking.

This would be manageable if 50 other worries weren't already darting around in my head as I sit in my new neurologist's office for the first time, waiting for the doctor's assistant to return.

I had tried to time it so that I took my Xanax dosage a half hour before I left the office, but I've been using benzos for years to treat my Generalized Anxiety Disorder and I still haven't hit my pill-popping stride without facing marginal issues. I'm really bad with timing and no matter how mindful I try to be of my anxiety levels, I am not always on top of my shit -- because my shit happens to enjoy fluctuating without announcing itself in ways other than screaming thoughts and/or dissociative states, among other things.

Sometimes, when fight or flight hits, I resort to denial, instead of admitting that I am experiencing a real chemical reaction.

Also, are you aware of how much effect the fight or flight response has on your body? Check this wiki page. It is a thing everyone experiences from time to time, but is obviously not meant to be a chronic state of being. (And consider, I feel this sensation near-daily unless I happen to time my meds just right.) Physiological effects include headaches, muscle tension and pain, chest pain (I've had costochondritis often and it is weird), fatigue, changes in sex drive, upset stomach, blah blah blah blah blah.

My brain in my body's worst enemy and my first impulse is to be able to control it myself, without help. Because stigma, social conditioning, and circumstance make barriers that take ages to break. Every time I take a Xanax, I feel like I'm surrendering to something I shouldn't -- but the relief and level of normalcy it brings in allowing me to function is precious, so why the hell do I continue to fight the ability to take something that so clearly benefits me?

Because there are some things I have no control over and I am straight up unable to think properly or rationally all the time.

(I realize I'm just asking myself questions and answering them at this point, but I swear I feel better for it.)

Back in the sterile office, the neurologist's assistant confirms that my blood pressure is on the higher end of normal despite my efforts to breathe it down. I become defensive on instinct -- previous doctors have made me take daily at-home blood pressure tests to be sure I didn't have chronic hypertension.

"It's just anxiety," I explain as soon as I see the reading.

She waves her hand noncommittally.

"That happens sometimes! The doctor will be right with you."

I spend most of my time waiting, swinging my feet, thinking about how I should have done this sooner.

When she eventually walks in, the first words out of her mouth are "Oh, I LOVE your hair!" as she shakes my hand and gets right down to business.

She is impressed by the amount of info I'd brought with me as I'd been using the My Pain Diary app to track my latest 3-month migraine, verbalizing a personal note to tell her other patients about it. After a lot of questions and a lengthy neurological exam that felt like a strange dance (touch my nose, now touch your nose, now walk like this...), she determines I suffer from common chronic migraines without aura. Not exactly a surprise.

She recommends starting me on Topamax, working up to 100 mg a day, rising to 200 if needed. She prescribes physical therapy for my head, neck, and shoulders. She mentions needing to see an opthamologist to test for papilledema (optic disc swelling that is caused by increased intracranial pressure) and something about a spinal tap if absolutely necessary. Oh, and I'm scheduled for an updated MRI.

Among all the words she's throwing at me (the details of which she prints neatly onto scripts and papers to take with me) I hear her mention, "...One of the main side effect is weight loss."

"Oh, okay."

Another round of mental and emotional bullshit comes on with a wave of nausea.

The digital number 244 that appeared on the scale I'd just stepped on at the beginning of my visit flashes in my brain. The fact I've gained 10 pounds in the past year rises to the top of the thought pyramid, before my anxieties concentrate on the wedding dress I bought that I'm afraid of fitting into for our ceremony this summer.

According to the BMI chart I register at a 38.2, the closest I've ever been to the dreaded "deathfat."

All of these factors together can make it hard to separate truth from fiction about the data surrounding the ties between migraines and obesity -- especially because on many levels, I was raised to believe weight loss could cure everything.

As I tend to do whenever I find myself stuck in a familiar loop of internalized body issues, I turned to my dear friend and fat activist Amanda Levitt (fellow mod at Redefining Body Image, co-mod of This Is Thin Privilege, and author of the blog Fat Body Politics) for some perspective. We discussed how there are lots of studies in the media that say migraines are linked to obesity, while also implying that weight loss can be a possible cure.

But as Amanda explains, "It's always super important when seeing articles cite studies to note that using words like 'linked' or 'risk' does not mean fatness CAUSES something. [Just because studies show there is a link] doesn't mean there is a causal relationship. Fat people are much more likely to live in poverty, deal with significant social stigma, stress, etc."

This makes sense when you consider the prevalence of migraines in relation to age, race, income, and other sociodemographic factors:

Migraine prevalence was strongly associated with household income; prevalence in the lowest income group (less than $10,000) was more than 60% higher than in the two highest income groups (greater than or equal to $30,000). The proportion of migraine sufferers who experienced moderate to severe disability was not related to gender, age, income, urban vs rural residence, or region of the country. In contrast, the frequency of headaches was lower in higher-income groups.

This is just one example of a study that shows there are far more specific ties to migraines than fatness, and yet another reminder that we should be careful not to take headlines and generalized statements in the media at face value.

I feel certain that my doctor did not prescribe me Topamax for its possible weight loss side effects, but that small mention stuck with me as the hardest to process, because it comes with the most baggage.

As I do with anything else I process, I study my experiences and document my thoughts and feelings as I take the time to fully comprehend my situation. When it comes to my health and mental well being, hasty decisions are not preferred. I am not exactly the type to start something new and possibly life-changing without over-thinking every single aspect of it.

I haven't picked my scrip up from the pharmacy yet -- it's waiting for me to grab after therapy tonight. I keep telling myself that this drug, paired with some altered ways of living and eating that I've been putting in place, MAY result in weight loss.

I'm accepting it as a reality or a possibility and not a thing to aspire to, because the moment I start banking on it -- disorder sets in. And I am prepared to avoid that from happening.