How well are preventive medications tolerated
Perhaps 20% of patients discontinue each of the preventive medications due to side effects.
The physician should discuss the side effect profile with the patient before starting. For example, divalproex can cause nausea, somnolence, tremor, dizziness, weight gain, and hair loss.
Caution should be used in prescribing divalproex or any valproic acid derivative to women of childbearing potential because of the risk for teratogenicity including major malformations and adverse cognitive and developmental outcomes.
Topiramate can cause paresthesias, changes in taste (soft drinks may taste flat), depression, kidney stones in about 1%, reversible cognitive impairment in about 10%, weight loss, and rarely glaucoma.
