Low-dose sodium valproate versus low-dose propranolol in prophylaxis of common migraine headache: A randomized, prospective, parallel, open-label study

Abstract

CONTEXT:Migraine is the second most common headache disorder. However, prophylactic therapy remains underutilized.AIMS:The objective of the study was to compare the efficacy and safety of low-dose sodium valproate and low-dose propranolol sustained release (SR) in the prophylaxis of common migraine headache.SETTINGS AND DESIGN:The study was conducted in a tertiary care teaching institute. It was a randomized, prospective, parallel, open-label, clinical study.SUBJECTS AND METHODS:The study included 60 patients with common migraine headaches (≥2 attacks/month) treated for 12 weeks. The patients were randomly divided into two treatment groups treated by sodium valproate 500 mg/day and propranolol SR 40 mg/day, respectively. The primary outcome measures were the percentage of responders (i.e., >50% decrease in mean headache frequency) at the end of 12 weeks and decrease in mean headache frequency (per 4 weeks) at the end of 12 weeks. The patients were assessed at 0, 4, 8, and 12 weeks of the study.STATISTICAL ANALYSIS USED:Intention-to-treat analysis was used for all the statistical analysis.RESULTS:Fifty-five patients completed the study. At the end of the treatment, both sodium valproate and propranolol caused a significant (P < 0.0001) reduction in frequency, severity, and duration of migraine headache. Propranolol caused significantly greater reduction in the severity of headache (P = 0.0410) than sodium valproate. The percentage of responders was 60% in sodium valproate group and 70% in propranolol group. Drowsiness was the most common adverse effect noted in both the groups.CONCLUSION:Both sodium valproate and propranolol significantly reduced frequency, severity, and duration of migraine headache, but propranolol caused significantly greater reduction in the severity of headache compared to sodium valproate. Both the medications were well tolerated and did not result in discontinuation.

Effects of β-Blockers on the Sympathetic and Cytokines Storms in Covid-19

“…An experimental study by Danukalo et al illustrated that AngII increases firing and activity of LC with the propagation of sympathetic activation and hypertension in rats ( 40 ). Besides, β-blockers like propranolol modulate the activity and sensitivity of LC and prevent sympathetic stimulation in patients with migraines ( 41 ). Indeed, non-selective and lipophilic β-blockers like propranolol have a potent effect in the suppression of catecholamine from presynaptic adrenergic neurons through inhibition of excitatory presynaptic β2 autoreceptor ( 42 ).…”

Uso de anti-hipertensivos para profilaxia da enxaqueca em comparação com os anticonvulsivantes: uma revisão sistemática

“…Os anti-hipertensivos mais usados são os betabloqueadores e os antagonistas dos receptores da angiotensina II, enquanto os anticonvulsivantes mais empregados são o ácido valpróico, a gabapentina e o topiramato (Purdy, 2013). Apesar de seu efeito não ser totalmente compreendido, o mecanismo de ação do propranolol (beta bloqueador) é proposto na ideia de que ele reduz a excitabilidade do sistema nervoso central, realizando antagonismo em receptores beta1, o que causa diminuição da Contribuciones a Las Ciencias Sociales, São José dos Pinhais, v.17, n.1, p. [3855][3856][3857][3858][3859][3860][3861][3862][3863][3864][3865][3866][3867][3868][3869]2024 noradrenalina, como também a síntese de óxido nítrico (NO) é diminuído através da sua ação em receptores beta2 (Dakhale et al, 2019).…”

“…Dakhale et al (2019) esclareceram a melhora mantida dos seus medicamentos na sua pesquisa, com propranolol diminuído significativamente os episódios de enxaqueca, assim como a duração e a gravidade. Os autores ainda relataram que a porcentagem de reação adversa com o anticonvulsivante foi maior, porém não foi motivo de abono da pesquisa.…”