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Divalproex,
propranolol and valproate can be used as the most preferred choices for
reducing the monthly headache days, headache frequency and at least 50% reduction
in headache attacks, respectively.
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.
J Headache Pain. 2017; 18(1): 26.
Unveiling the relative efficacy, safety, and tolerability of prophylactic medications for migraine: pairwise and network-meta analysis
Aijie He et al.
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