Botox (onabotulinumtoxinA) and Topamax (topiramate) are brand-name drugs. They’re both prescribed to help prevent migraine headaches. Botox is given as multiple intramuscular injections in the head and neck, and Topamax comes as oral tablets or capsules.
This article explains the main similarities and differences between Botox and Topamax. If you’re considering taking one of these drugs, discussing this information with your doctor can help you decide whether one of these treatment options may be right for you.
Note: For more comprehensive information about these two drugs, you can refer to our Botox and Topamax articles.
Key differences between Botox and Topamax
These are a few of the main differences between Botox and Topamax:
- Dosage. For helping to prevent migraine headaches, Topamax is taken more often than Botox. (See the “Dosages, forms, and administration” section.)
- How it’s given. Topamax comes as a tablet that you swallow and as a capsule that can be opened and sprinkled on food. For helping to prevent migraine headaches, Botox is given as an injection into muscles in your head and neck.
- Conditions treated. Botox and Topamax are both prescribed to help prevent migraine headaches, but both drugs are also prescribed to treat other conditions. (See the “Uses of Botox vs. Topamax” section.)
Here’s information about the generic and biosimilar* status of Botox and Topamax, as well as their active ingredients.
| Botox | Topamax | |
| Generic or biosimilar available | no | yes |
| Active ingredient | onabotulinumtoxinA | topiramate |
| Drug class | neurotoxin | anticonvulsants |
* A biosimilar medication is a drug that’s similar to a brand-name biologic drug (also called the parent drug). Botox is a biologic medication, which is also referred to as a biologic.
Biologic drugs are made using living cells. It’s not possible to make an exact copy of these drugs. A generic, on the other hand, refers to drugs made from chemicals. A generic is an exact copy of the active drug in a brand-name medication.
Biosimilars are considered to be just as effective and safe as their parent drug. And similar to generics, biosimilars tend to cost less than brand-name medications.
Botox and Topamax have been approved by the Food and Drug Administration (FDA) to treat the following in adults.
- Both Botox and Topamax are FDA-approved to:
- help prevent migraine headaches
- Botox is also FDA-approved to treat:
- overactive bladder
- urinary incontinence caused by a nerve disorder
- limb spasticity (involuntary muscle contractions)
- cervical dystonia (involuntary muscle spasms in the neck)
- blepharospasm (uncontrollable blinking) caused by dystonia
- strabismus (misaligned or crossed eyes)
- severe axillary hyperhidrosis (excessive sweating in the armpits)
- Topamax is also FDA-approved to treat:
Botox or Topamax and children
Botox and Topamax may be prescribed to children for the following uses.
- Botox is FDA-approved to treat:
- limb spasticity (involuntary muscle contractions) in children ages 2 years and older
- blepharospasm (uncontrollable blinking) caused by dystonia in children ages 12 years and older
- strabismus (misaligned or crossed eyes) in children ages 12 years and older
- Topamax is FDA-approved to:
- treat certain seizures caused by epilepsy in children ages 2 years and older
- help prevent migraine headaches in children ages 12 years and older
Note: For more information about the drugs’ uses, see our articles about Botox and Topamax.
Here’s a quick look at the dosage and administration of Botox and Topamax for the conditions both drugs help prevent.
Dosage for helping to prevent migraine headache
The table below details dosages for helping to prevent migraine headaches for Botox and Topamax.
| Botox for helping to prevent migraine headaches | Topamax for helping to prevent migraine headaches | |
| Forms | solution for intramuscular injection | oral tablet and sprinkle capsule |
| Strengths | 100 milligrams (mg) and 200 mg | oral tablet: • 25 mg • 50 mg • 100 mg • 200 mg sprinkle capsule: • 15 mg • 25 mg |
| Dose | 155 units divided into 31 injections, each given into different muscles of your head and neck | 50 mg |
| Frequency | every 12 weeks | twice per day |
| Given by | healthcare professional (see below) | self |
If you are prescribed Botox to help prevent migraine headaches, a healthcare professional will prepare your doses. During your appointment, they’ll administer a total of 31 shallow injections into various muscles of your head and neck.
Both Botox and Topamax both help prevent migraine headaches. These drugs can cause some of the same side effects, as well as some different ones. Some of the side effects reported in clinical trials of these drugs are mentioned below.
For more details about side effects of the two drugs, see our side effect articles about Botox and Topamax. You can also refer to Botox’s prescribing information and Topamax’s prescribing information.
Mild side effects
The following table lists some of the more commonly reported mild side effects of Botox and Topamax. The table may also include mild side effects that are less common but that you might have concerns about in some cases.
| Mild side effects | Botox | Topamax |
| appetite loss | ✓ | |
| memory problems | ✓ | |
| change in your sense of taste | ✓ | |
| tingling or pins and needles sensation | ✓ | |
| diarrhea | ✓ | |
| headache | ✓ | |
| neck pain | ✓ | |
| worsened migraine | ✓ | |
| drooping eyelids | ✓ | |
| mild allergic reaction | ✓ | ✓ |
These side effects may be temporary, lasting a few days to weeks. If the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.
Serious side effects
The following table lists the reported serious side effects of Botox and Topamax.
| Serious side effects | Botox | Topamax |
| kidney stones | ✓ | |
| hyperthermia (high body temperature) | ✓ | |
| metabolic acidosis (high acid level in the blood) | ✓ | |
| hyperammonemia (high ammonia level in the blood) | ✓ | |
| serious skin reactions, such as Stevens-Johnson syndrome | ✓ | |
| mental health side effects, such as depression and suicidal thoughts or actions | ✓ | |
| eye-related side effects, such as vision loss | ✓ | |
| corneal ulceration, only in people receiving Botox to treat blepharospasm | ✓ | |
| difficulty swallowing or breathing | ✓ | |
| urinary retention, only in people receiving Botox to treat urinary incontinence | ✓ | |
| spread of toxin effects, which can be life threatening* | ✓ | |
| severe allergic reaction | ✓ | ✓ |
If you have serious side effects during treatment with Botox or Topamax, call your doctor immediately. If the side effects feel life threatening or you believe you’re having a medical emergency, call 911 or your local emergency number right away.
* Botox has a boxed warning for this side effect. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Precautions for Botox and Topamax” section below.
Suicide prevention
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
Below are answers to some common questions about Botox and Topamax.
Can I take Botox and Topamax together?
Yes, if your doctor determines it’s safe for you to do so. Topamax and Botox aren’t known to interact with each other. And both drugs are Food and Drug Administration (FDA) approved to help prevent migraine headaches.
Talk with your doctor to learn more about whether taking Botox and Topamax together is a possible treatment plan for your migraine headaches.
Is Botox a better treatment option than Topamax, or vice versa?
It depends. Botox and Topamax belong to different drug classes and cause different side effects. (Refer to these articles to learn more about side effects of Botox and Topamax.) Whether one or another is a better treatment option depends on your individual health needs and other factors specific to you.
For example, Botox is approved to help prevent migraine headaches if you have 15 or more migraine episodes per month. If you have fewer than 15 episodes per month, Topamax may be a better option for you.
Topamax is typically taken twice daily to help prevent migraine headaches. With Botox, you only need to receive your dose once every 12 weeks.
Talk with your doctor if you’re considering treatment with Topamax or Botox. Your doctor can advise on whether one of these drugs may be a better option for you.
You may wonder whether Topamax or Botox is more effective for helping to prevent migraine headaches.
Comparison study. Here’s a brief look at whether Botox or Topamax was found to be more effective for helping to prevent migraine headaches.
One
Treatment guidelines. Another way to find out whether a drug is considered effective is to look at treatment guidelines. When an organization includes certain drugs in treatment guidelines, this means that research has shown the drug to be safe and effective. Both Topamax and Botox are recommended as treatment options for helping to prevent migraine headaches in guidelines from the
How much Botox or Topamax costs depends on the treatment plan your doctor prescribes, your insurance plan, and your pharmacy. You can visit Optum Perks* for price estimates on Topamax oral tablet and Topamax sprinkle capsules.
Both Botox and Topamax are brand-name drugs. Botox is only available as a brand-name drug. Topamax also comes in a generic form. Brand-name medications are often more expensive than generics. Talk with your doctor or pharmacist to learn about the generic form of Topamax.
* Optum Perks is a sister site of Medical News Today.
Botox and Topamax may not be right for you if you have certain medical conditions or other factors that affect your health. The two drugs share some of the same precautions, but they also have different ones. Some of these precautions are mentioned below.
Boxed warning: Spread of toxin effects
Botox has a boxed warning for the spread of toxin effects. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.
In rare cases, the effects of Botox may spread from the site where the drug is injected and enter other areas of the body. This can result in a condition called botulism. Symptoms can include muscle weakness, drooping eyelids, and difficulty breathing, speaking, or swallowing.
Botulism can occur within hours after a Botox injection. But other times, symptoms may not appear for days or even weeks.
If your symptoms feel life threatening, such as trouble breathing, immediately call 911 or seek emergency medical attention. If you have non-life-threatening symptoms after receiving a Botox injection, tell your doctor right away.
Precautions
In addition to boxed warnings, Botox and Topamax have other warnings.
If any of the following medical conditions or other health factors are relevant to you, talk with your doctor before starting Botox or Topamax.
| Precaution | Botox | Topamax |
| you’ve had an allergic reaction to either drug or any of its ingredients | ✓ | ✓ |
| you’re pregnant or thinking about becoming pregnant | ✓ | ✓ |
| you’re breastfeeding or thinking about breastfeeding | ✓ | ✓ |
| you have a mental health condition, such as depression | ✓ | |
| you have glaucoma | ✓ | |
| you have a breathing problem | ✓ | ✓ |
| you have a kidney condition, such as chronic kidney disease | ✓ | |
| you have osteoporosis or another condition causing weak bones | ✓ | |
| you have a liver condition, such as liver cirrhosis | ✓ | |
| you have a bladder condition, such as kidney or bladder stones | ✓ | |
| you have a neuromuscular disorder, such as myasthenia gravis | ✓ |
Note: For more comprehensive information about these two drugs, you can refer to our Botox and Topamax articles.
Switching between Botox and Topamax is possible.
If you’d like to know more about switching between Botox and Topamax, talk with your doctor. They can give you additional details and help determine the best course of action for your personal situation. It’s important to note that even if two drugs treat the same condition or are in the same drug class, your body can still respond differently.
Do not stop, start, or switch any of your drug treatments without your doctor’s recommendation.
Some key points to remember when comparing Botox and Topamax include the following:
- Uses. Botox is only approved for use in adults for helping to prevent migraine headaches. Topamax may be prescribed to adults and children ages 12 years and older for this use.
- Forms. Botox is given as an intramuscular injection. Topamax comes as an oral tablet and as a capsule that can be opened and sprinkled on food.
- Dosages. For helping to prevent migraine headaches, Topamax is taken daily. Botox is given as an injection every 12 weeks.
If you’d like to learn more about Botox or Topamax, talk with your doctor or pharmacist. They can help answer any questions you have about similarities and differences between the drugs. They can also help determine whether one drug or the other might work well for you.
Note: For more information about migraine, see our headache and migraine hub.
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.