目的　观察托吡酯不同起始剂量治疗枕神经痛的疗效。方法　由成都市 5家医院神经内科组成协作组 ,将 133例枕神经痛患者随机分为托吡酯A、B组 (起始剂量分别为 5 0mg/d和 2 5mg/d)及卡马西平组。托吡酯A、B组在治疗后第 2d开始每天加 2 5mg,最大剂量 2 0 0mg/d,卡马西平组为 0 1每日 3次 ,共治疗3周。对 3组患者每周进行自评、医评 ,并比较其疗效和不良反应。结果　治疗第 1周卡马西平组疗效优于托吡酯A、B组 (均P <0 0 5 ) ,而A组疗效又优于B组 (P <0 0 5 ) ,第 2周和第 3周 3组间疗效无差异 (均P >0 0 5 )。 3组患者出现的不良反应轻 ,发生率亦无差异。结论　用托吡酯治疗枕神经痛起始剂量 5 0mg/d比 2 5mg/d起效快 ,无严重不良反应。 Objective To observe the curative effect of different initial doses of topiramate on occipital neuralgia. Methods A total of 133 patients with occipital neuralgia were randomly divided into two groups: topiramate A and B (initial dose of 50 mg / d and 25 mg / d) and carbamazepine respectively. Topiramate A, B group in the first 2d after treatment plus 25mg daily, the maximum dose of 200mg / d, carbamazepine group 0 1 3 times a day for a total of 3 weeks. Three groups of patients each week for self-assessment, medical evaluation, and compare their efficacy and adverse reactions. Results The curative effect of carbamazepine group on week 1 was better than that of topiramate A and B group (all P <0.05), but the curative effect of group A was superior to that of group B (P <0 05) There was no difference between the three groups (all P> 0.05). Adverse reactions occurred in 3 groups of patients with mild, the incidence was no difference. Conclusion Topiramate for the treatment of occipital neuralgia starting dose of 50mg / d faster than 25mg / d onset, no serious adverse reactions.