Can Migraine Medication Cause Kidney Stones? Understanding the Risks

A 2025 study found that users of certain migraine prevention drugs, like topiramate and zonisamide, face up to a 58% increased risk for kidney stones. So, can migraine medication cause kidney stones? The answer for specific types is yes.

Quick Summary

Certain preventive migraine medications, specifically topiramate and zonisamide, are linked to a higher risk of developing kidney stones by altering urine chemistry. Proactive management can lower this risk.

Key Points

• Primary Culprits: The migraine prevention drugs topiramate and zonisamide are most strongly linked to an increased risk of kidney stones.

• Mechanism: These drugs inhibit carbonic anhydrase, leading to lower urinary citrate, higher urine pH, and metabolic acidosis—a trio that promotes calcium phosphate stone formation.

• Quantified Risk: Studies show that users of topiramate or zonisamide may have up to a 58% higher risk of experiencing a kidney stone event.

• Prevention is Key: The risk can be managed by increasing fluid intake to over 2 liters daily and through potassium citrate supplementation.

• Diet Matters: Limiting sodium, animal protein, and high-oxalate foods can also help reduce the risk of kidney stones.

• Safer Alternatives: Other classes of migraine medications, such as triptans, CGRP inhibitors, and beta-blockers, are not associated with a high risk of kidney stones.

• Reversible Effects: The metabolic changes that increase stone risk are typically reversible after discontinuing the medication.

The Link Between Migraine Treatment and Kidney Health

Some preventive migraine medications, particularly the anticonvulsants topiramate (Topamax) and zonisamide (Zonegran), are associated with an increased risk of kidney stones. Research, including a study in the American Journal of Kidney Disease in June 2025, has demonstrated that patients taking these drugs have a higher likelihood of experiencing a kidney stone event. This risk warrants careful consideration by both patients and healthcare providers, especially for individuals with a history of calcium kidney stones.

How Do These Medications Increase Kidney Stone Risk?

The elevated risk stems from how topiramate and zonisamide affect the body's acid-base balance and urine composition. They inhibit carbonic anhydrase, an enzyme, which leads to several changes:

1. Metabolic Acidosis: An increase in blood acidity.
2. Increased Urine pH: Urine becomes more alkaline as the body attempts to compensate.
3. Decreased Urinary Citrate: Lower levels of citrate, a natural inhibitor of stone formation, in the urine.

These changes create a favorable environment for the development of calcium phosphate kidney stones. The risk appears to be related to the dose of medication.

Identifying Symptoms and Managing Risks

Symptoms of kidney stones can include severe pain, blood in the urine, nausea, and vomiting. Managing the risk involves strategies to counteract the chemical changes caused by the medication. Effective prevention methods include:

• Hydration: Drinking more than 2 liters of water daily dilutes urine.
• Potassium Citrate: Supplementation can increase protective urinary citrate levels.
• Diet: Adjustments like reducing sodium and animal protein intake, and limiting high-oxalate foods, can help.
• Monitoring: Urine tests can help healthcare providers tailor preventive measures.

Comparison of Migraine Medications and Kidney Stone Risk

Different migraine medications carry varying levels of kidney stone risk.

Medication Class	Examples	Kidney Stone Risk	Mechanism/Notes
Anticonvulsants	Topiramate, Zonisamide	High	Inhibit carbonic anhydrase, leading to changes in urine chemistry that promote stone formation.
Triptans	Sumatriptan, Rizatriptan	Low / Case-Specific	Generally safe for kidneys, though caution is needed in severe renal impairment.
NSAIDs	Ibuprofen, Naproxen	Low (with caution)	Can affect kidney function, especially with existing kidney disease.
CGRP Inhibitors	Erenumab, Fremanezumab	Very Low / Rare	Low risk, but rare cases of allergic kidney reactions reported.
Beta-Blockers	Propranolol, Metoprolol	Very Low	Generally safe for kidney health and not linked to increased stone risk.

Conclusion: A Matter of Informed Decision-Making

While certain migraine medications, namely topiramate and zonisamide, can increase the risk of kidney stones, this risk is manageable. The metabolic effects are often reversible upon stopping the medication. The decision to use these drugs should involve a thorough discussion with a healthcare provider to weigh the benefits and risks and consider preventive strategies. Proactive measures like increased fluid intake and potassium citrate can help mitigate the risk.

For more detailed dietary guidance on kidney stone prevention, an authoritative resource is the National Kidney Foundation.

Frequently Asked Questions

Which specific migraine medications cause kidney stones?

The primary migraine medications associated with an increased risk of kidney stones are topiramate (Topamax) and zonisamide (Zonegran). These are anticonvulsant drugs often used for migraine prevention.

How does topiramate cause kidney stones?

Topiramate inhibits an enzyme called carbonic anhydrase. This leads to decreased citrate (a stone inhibitor) in the urine, increased urine pH (more alkaline), and mild metabolic acidosis, creating an environment favorable for calcium phosphate stone formation.

Is the kidney stone risk from topiramate permanent?

No, studies have shown that the metabolic disturbances, such as low urinary citrate and high urine pH, are reversible after the medication is stopped.

Can I prevent kidney stones while taking topiramate for migraines?

Yes, prevention is possible. The most effective strategies include significantly increasing your daily fluid intake (aiming for >2L of urine output) and taking potassium citrate supplements as prescribed by your doctor to counteract the chemical changes in your urine.

Do triptans like sumatriptan (Imitrex) cause kidney stones?

Triptans are generally not associated with causing kidney stones. They are primarily metabolized by the liver and considered to have a low risk for kidney-related side effects, though caution is advised in patients with severe, pre-existing kidney impairment.

What about the newer CGRP inhibitors? Do they affect the kidneys?

CGRP inhibitors are generally considered unlikely to cause kidney damage. However, there have been very rare reports of acute interstitial nephritis, an allergic kidney reaction, in some patients after prolonged use.

Should I stop taking my migraine medication if I'm worried about kidney stones?

You should not stop taking any prescribed medication without first consulting your healthcare provider. They can assess your individual risk, discuss alternative treatments, and recommend preventive strategies if you continue the medication.