The effect of sodium valproate on chronic daily headache and its subgroups

Abstract

The objective of the study was to assess the efficacy and tolerability of sodium valproate (VPA) on chronic daily headache (CDH) in a prospective, double-blind, randomized, placebo-controlled trial. Seventy patients were included in the study. Twenty-nine had chronic migraine (CM) and 41 had chronic tension-type headache (CTTH). VPA and placebo were applied for 3 months to 40 and 30 patients, respectively. Visual analog scale (VAS) and pain frequency (PF) were used for evaluation. VPA decreased the maximum pain VAS levels (MaxVAS) and PF at the end of the study (P = 0.028 and P = 0.000, respectively), but did not change general pain VAS (GnVAS) levels (P = 0.198). In CM patients, the decreases in MaxVAS, GnVAS and PF parameters were more in VPA treated patients (P = 0.006, P = 0.03, and P = 0.000, respectively). VPA treatment caused more reduction in PF than placebo in the CTTH subgroup (P = 0.000). VPA is effective in the prophylactic treatment of CDH by reducing MaxVAS levels and PF. It was more effective in CM than in CTTH.

Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society

“…In one RCT of 70 patients (29 CM, 71 CTTH patients) [57], sodium valproate (500 mg bid) for 3 months was superior to placebo for both general and maximum pain levels, and headache frequency, more so in CM than in CTTH. The number-needed-to-treat for reduction in headache frequency was 4, but this study is very atypical because of the complete absence of a placebo response.…”

The diagnosis and treatment of chronic migraine

“…Whilst NICE has recently recommended topiramate as the first-line preventive (on the basis that this medication has the most extensive high-quality clinical trial evidence on which to base the decision), most headache specialists continue to start with other older medications, probably of equivalent efficacy and certainly better tolerated, such as tricyclics (amitriptyline [Dodick et al 2009], nortriptiline or dosulepin), β blockers (propranolol [Linde and Rossnagel, 2004], atenolol, nadolol or metoprolol). If these do not work then anticonvulsants such as topiramate [Diener et al 2007;Silberstein et al 2007;Mulleners et al 2015] or sodium valproate [Yurekli et al 2008;Mulleners et al 2015] can be considered. The calcium channel blocker flunarizine may be helpful [Diener et al 2002], and anecdotally is said to be the drug of choice for patients with prolonged aura, hemiplegic attack or prominent vertigo.…”

Latin American consensus on guidelines for chronic migraine treatment

“…There are class I studies with evidence level A for onabotulinumtoxinA 70,71 and topiramate [72][73][74] , and one of evidence level B for sodium valproate 75 . The preventive treatment duration of chronic migraine is not established, but there are data showing a substantial relapse rate in patients treated for one year or less with its early suspension (less than one year) 54,74 .…”