ok, speaking from experience....
When i started at the lowest dosage and PROPERLY increased the medication I did really well and had a great reduction in migraines as well as few side effects and weight loss.
However, I lost insurance and had to start over...I started too high with the dosage and increased it too quickly, I was nauseated and felt stupid, I could not remember words and would get lost when I was driving to places that I should have known where they were.
When I took Topamax consistently it worked better as a preventative than ANYTHING ELSE I have taken.