Carbonation and Sweet Taste Dysgeusia with Topiramate Therapy for Migraine Prevention Treatment: a Case Report

Migraine is a common disorder with a reported prevalence of up to 12% in the European general population. It has been shown to cause a reduction in quality of life with symptoms that range from headaches, nausea, and vomiting to external stimuli hypersensibility. Migraine preventive treatment identifies numerous medication groups including anticonvulsants such as topiramate. We report the first case of carbonated and sweet taste dysgeusia during topiramate treatment for migraine prevention. We present the case of a 30-year-old man with a 6-month history of headache with aura associated with nausea, vomiting, photophobia, and blurred vision. A preventive migraine therapy with topiramate was started. After 4 weeks, the patient developed carbonation and sweet taste dysgeusia determining a major impact on quality of life and low therapy adherence. To improve patient’s quality of life, we attempted to switch therapy from topiramate to sodium valproate, but his noncompliant behavior imposed us to continue the current therapy. Thus, the patient was sent for a psychological evaluation and counseling eventually accepting to continue therapy. To date, no reports have been published in the literature on coexistent carbonation and sweet taste dysgeusia linked to topiramate migraine preventive therapy. We hypothesize that topiramate, modulating GABAergic transmission, could influence sweet taste transmission at the taste bud level in an already modulated taste receptor environment. Although dysgeusia causes are still not well defined, it is mandatory to correctly inform patients on the possible side effects of migraine preventive therapy, introducing psychological counseling, if needed, to integrate challenging therapies.