For which patient population is topiramate particularly attractive due to weight loss and migraine reduction?

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Topiramate offers two useful effects for migraine prevention: reducing migraine frequency and causing weight loss. For patients who are overweight or obese, this dual benefit is particularly advantageous because it addresses both the headaches and the obesity-related factors that can worsen migraines. In contrast, weight loss would be undesirable in someone who is underweight, and the elderly with frailty or athletes might be more likely to experience cognitive side effects or other risks that make the weight-reducing effect less desirable. Therefore, overweight/obesity is the population that stands to gain the most from topiramate’s combination of migraine relief and weight loss.