Divalproex Sodium and Topiramate for Migraine Prophylaxis

Aim: To compare the efficacy, safety of topiramate and extended-release divalproex sodium in migraine prophylaxis. Material and Method: Study groups consisted of 22 patients with chronic migraine, randomly administered 1000 mg extended-release divalproex sodium (first group), 21 patients given 100 mg topiramate (second group).Study was 28-week randomized, prospective trial including 4-week baseline, 4-week titration, 20-week maintenance phase.Primary efficacy measure was reduction from baseline in 4-week migraine frequency.Secondary efficacy measures included responder rates, mean reduction in migraine duration,severity.Severity of headache was quantified by using 10-point visual analogue scale (VAS). Responder rates were defined as percentage of patients who demonstrated ≥ 50%. reduction in migraine frequency per month. Results: Reduction from baseline migraine frequency at the end of six month was primary outcome measure.Mean migraine frequency at the end of study was 1.27 ± 1 (baseline; mean ± SD: 3.6 ± 2) in the first, 1.2 ± 1.2 (baseline; mean ± SD: 3.5 ± 2.3) (p<0.0001) in the second group.Significant improvement in frequency was observed in 16 patients (72.7%) in the first group, and 16 patients (76.2%) in the second group.Only a limited number of patients were excluded from the study due to side effects as 2 patients from the first group and 1 patient from the second group.The most common side effect was weight gain in the first and paresthesia in the second group. Discussion: Both divalproex sodium, topiramate were almost equally effective in reducing migraine frequency, duration, severity.Total relief from migraine attacks were more in topiramate than extended-release divalproex sodium.