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Topiramate is contraindicated in pregnancy for migraine prophylaxis and requires highly effective contraception and signed risk acknowledgement for women who could become pregnant

In the first year following diagnosis, we found increased cumulative incidence risk ratios in a number of outcomes including: - Any mental, behavioural, or neurodevelopmental disorder 1.96 (1.93 - 1.99) - Postpartum depression 2.70 (2.61 - 2.79) - Eating disorders 2.06 (1.85 - 2.89) - PTSD 1.77 (1.69 - 1.86) We also saw significantly increased risk in rare but serious outcomes such as: - Wernicke's encephalopathy 2.39 (1.25 - 4.56) - Puerperal psychosis 1.80 (1.48 - 2.20) Interestingly, cases of hyperemesis gravidarum with metabolic disturbance displayed a significantly lower risk of any depression and postpartum depression compared with those without metabolic disturbance

These episodes usually run like clockwork, depending on the individual

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The secretion of inflammatory cytokines, such as tumor necrosis factor (TNF)-a, would lead to neuroinflammation and migraine episodes by increasing the cellular permeability and interactions