I would have to agree with Ann. At 200 mg you should be getting some pain relief. I take topomax as well, and in the beginning the side effects (especially the tingling/numbness in the feet/legs/hands/arms was horrible!) were really bad. The first neurologist that put me on topomax put me on 100 mg (not at once, but that was the dosage it moved to) and the side effects were so bad I would have to go to bed as soon as I took the pills b/c of the dizziness, nausea, and fatigue. I took myself back down to 50 mg, which is were topomax seems to work for me. Unfortunately, it doesn't work for everyone. Are you going to a neurologist who specializes in migraines? Often they know of more medications and treatment options for migraines than a regular neurologist does. Sending healthy thoughts your way!