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Valproate for Adult Migraine Prophylaxis

 


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Am Fam Physician. 2016 Nov 1;94(9):online.

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VALPROATE FOR ADULT MIGRAINE PROPHYLAXIS

BenefitsHarms

1 in 5 experienced 50% or greater reduction in migraines

1 in 7 experienced adverse effects such as nausea, tremor, or vertigo

VALPROATE FOR ADULT MIGRAINE PROPHYLAXIS

BenefitsHarms

1 in 5 experienced 50% or greater reduction in migraines

1 in 7 experienced adverse effects such as nausea, tremor, or vertigo

Details for This Review

Study Population: Patients 16 years or older with episodes of migraine headache on at least 15 days of every month

Efficacy End Points: 50% or greater reduction in migraines after one month of treatment

Harm End Points: Adverse effects such as fatigue, vertigo, nausea, tremor, and weight gain

Narrative: Migraines are the sixth most common cause of disability worldwide and affect more than 10 million U.S. adults annually.1,2 Daily antiepileptic medications are commonly used to prevent migraine headaches. A 2013 Cochrane review assessed evidence on the efficacy and tolerability of valproate medications (valproic acid [Depakene] or divalproex sodium [Depakote], or a combination of both) in migraine prophylaxis. Ten randomized trials enrolled 2,296 patients 16 years or older with migraines occurring on at least 15 days per month. The studies compared valproate to a placebo or other medications. The analysis demonstrated that significantly more patients treated with divalproex sodium met their definition of success compared with those receiving placebo, with a number needed to treat (NNT) of 5 (95% confidence interval [CI], 4 to 8). Vertigo, nausea, and tremor were increased compared with placebo, whereas the frequency of other adverse effects (fatigue, weight gain, cumulative adverse effects) were not significantly different.3

Caveats: The 10 small trials in this

Author disclosure: No relevant financial affiliations.

REFERENCES

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1. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385(9963):117–171....

2. Tepper SJ. A pivotal moment in 50 years of headache history: the first American Migraine Study. Headache. 2008;48(5):730–731.

3. Linde M, Mulleners WM, Chronicle EP, McCrory DC. Valproate (valproic acid or sodium valproate or a combination of the two) for the prophylaxis of episodic migraine in adults. Cochrane Database Syst Rev. 2013;(6):CD010611.

4. Morrell MJ. Reproductive and metabolic disorders in women with epilepsy. Epilepsia. 2003;44(suppl 4):11–20.

5. Evers S, Afra J, Frese A, et al. European Federation of Neurological Societies. EFNS guideline on the drug treatment of migraine—revised report of an EFNS task force. Eur J Neurol. 2009;16(9):968–981.



 

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