The comparative study of sodium valproate and topiramate as prophylactic therapy for migraine in Imam hospitals of Tabriz and Urmia, Northwestern Iran

Abstract

Introduction: Migraine, generally unilateral and throbbing, is a periodic headache with a genetically background. It begins from childhood, adolescence or early in middle age and is more common among the women. According to conventional terminology two main clinical syndromes associated with migraine: migraine with and without aura. Although extensive studies and hypotheses have been done, the definite pathology of migraine is not clear. However, two main neurogenic and vasogenic hypotheses are generally accepted. Although the criteria proposed by ICHD-2 are suitable for research purposes, almost physicians diagnose the migraine based on its general manifestations. The 80% of the untreated patients will suffer moderate to severe pains and only in 20% of the cases they experience a mild pain. In this study, we tried to evaluate the general and detailed effects of sodium valproate and topiramate as a prophylactic therapy for migraine episodes. Materials and Method: This is a double-blind study, which was conducted in the main hospitals of Tabriz and Urmia, the capitals of both main provinces of northwestern Iran, on 200 patients with migraine who needed prophylaxis. Of them, 150 cases were female and 50 cases were male. They all were grouped in two groups, each group included: 75 females, and 25 males, in order to avoid the bias. The first group received sodium valproate (15-30 mg/kg) and the second group received topiramate 2-3 mg/kg. Medication discontinuing occurred in 10% of topiramate-treated patients and occurred in 5% of sodium valproate-treated patients. The prophylactic therapy continued 2-3 months after healing. Results: According to the results of this study, the administration of topiramate and sodium valproate in two different treatment groups, caused a 50% decrease in the headache frequency in 80% of the patients in both groups. They cause also a 75% decrease of the headache in 15%, and in the rest of 5% of the patients the headache completely prohibited and went away in both groups. These two groups had no significant difference in the average ages of the cases (p> 0.05). The effects of both drugs were identical in decreasing the frequency, intensity, and elongation of the headaches, and there were no significant differences in the results of both groups (p>0.05). The discontinuing the therapy occurred 10% with topiramate (males 4%, females 6%) and 5% of cases with sodium valproate (males 2%, females 3%). This demonstrated the higher incidence of therapy termination in the female cases with both drugs. According to the results of our study, sodium valproate and topiramate had the same efficacy and potency in prophylaxis of the severe migraine (p> 0.05). According to the results of our study, sodium valproate decreased the headache frequencies from 6 to 0.6 cases per month, and topiramate decreased this rate from 6 to 1 cases per month. Conclusion: Reviewing the literature and according to the results of our study, that they all agree that both sodium valproate and topiramate have identical effects on prophylaxis of severe migraine episodes, we suggest using sodium valproate for thin and topiramate for fat patients. In this study, we found that sodium valproate decreases the headache frequencies from 6 to 0.6 cases per month, and topiramate decreases this rate from 6 to 1 cases in the same period.