Topiramate - why treat the symptoms when you could treat the cause?

Migraine is a very common disorder characterized by a headache and associated features with or without the presence of an aura. For many years it has been a poorly understood condition but now we know that the underlying disorder of a migraine is due to brainstem sensitization aka hyperexcitability of the neurons in the brainstem (1). Topiramate, brand name Topamax, is a preventative medication that has been used to treat migraines although it’s original use, and is still commonly used, as an anti-epileptic drug. So why are we using an anti-epileptic medication to treat migraines, how does it help, what do you need to know and could there be a better option?