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PubMed StatPearls

In migraine prophylaxis, preclinical models suggest that topiramate dampens cortical spreading depression, attenuates trigeminovascular calcitonin-gene-related-peptide release, and down-regulates central nociceptive transmitter traffic-mechanisms distinct from its antiepileptic activity but still rooted in excitatory-inhibitory balance

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Insurers are permitted to set their own PA thresholds above FDA-label minimums as a cost-management measure