A recent pairwise meta-analysis and network meta-analysis examined the relative efficacy, safety, and tolerability of prophylactic medications in the management of migraine.

In this study, an extensive literature search was done for popular prophylactic medications used for migraine management. A summary effect was produced by synthesizing both direct and indirect evidence for migraine headache days, headache frequency, at least 50% reduction in headache attacks, all adverse events, nausea, sleepiness, dizziness, and withdrawal due to adverse events.

Results indicated that patients with three interventions exhibited significantly less average migraine headache days as compared to those treated with placebo (topiramate, propranolol, divalproex). Topiramate and valproate were shown to possess a significantly increased likelihood of at least 50% reduction in migraine attacks as compared to placebo. Patients taking topiramate and propranolol showed significantly reduced headache frequency compared to those with placebo. A significantly higher risk of nausea was found to be associated with patients administered with divalproex when compared to those with placebo, topiramate, propranolol, gabapentin, and amitriptyline. Finally, divalproex was found to have an increased risk of withdrawal when compared to placebo and propranolol.

Overall, it was inferred from the results that topiramate, propranolol, and divalproex could be more efficacious than other prophylactic medications. However, the safety and tolerability of divalproex should be further verified by future studies.