Pediatric Migraine Prophylaxis With Divalproex

Abstract

We followed 23 patients with pediatric migraine, ranging in age from 7 to 17 years, who were treated with preventive divalproex sodium for migraine prophylaxis. Patients were evaluated for the presence or absence of comorbid psychiatric disorders or epilepsy to assess the possible differential effects of divalproex therapy. Doses ranged from 3.1 to 32.9 mg/kg/day. Seven patients had comorbid psychiatric disorders, whereas six patients had epilepsy (three rolandic, two generalized, and one indeterminate). Fifteen patients had a greater than 50% reduction in migraine; six patients became headache free. Divalproex doses used were not statistically different among the three groups. A favorable response and headache freedom were more likely in patients with migraine alone or with comorbid epilepsy, and less likely in patients with psychiatric comorbidity. Divalproex was well tolerated, and no significant side effects were reported. No notable changes were noted in behavioral problems, and patients with epilepsy were well controlled. In our cohort of patients, divalproex was most effective in patients with migraine alone or comorbid epilepsy.

Chronic disorders with episodic manifestations: focus on epilepsy and migraine

“…98 This approach can reduce side-effects of polypharmacy, and can even be particularly effective, as has been reported with the use of valproic acid for migraine prophylaxis in children with epilepsy. 99 Regulatory studies showed that 100 mg per day of topiramate is an effective monotherapy for both epilepsy and migraine, although this finding might not indicate the necessary dose for concomitant treatment. Although the attempt to treat comorbid disorders with one drug has potential merit, caution must be exercised to avoid undertreating one of the disorders.…”

Preventive therapies of pediatric migraine

“…Caruso et al [2000] studied this medication prospectively at doses of 10-30 mg/kg/day in 42 patients with mean age of 11.3 years It was effective in reducing headache frequency and generally well tolerated with side effects related to gastrointestinal upset and weight gain. A retrospective study of 23 patients ranging in age from 7 to 17 years also noted significant improvement in the number of migraine attacks [Pakalnis et al, 2001]. Many of these patients also had co-morbid epilepsy or psychiatric/behavioral disorders.…”

Episodic Migraines in Children

“…65,69 Nonrandomized studies suggested that 84% of children experienced adverse effects with divalproex 87 and that 17% discontinued treatment due to bothersome adverse effects. 88 A single unpowered randomized controlled trial examined the risk of individual adverse effects and found no significant differences with divalproex versus placebo based on sparse data. 69 Upper respiratory tract infections were more common with larger doses of divalproex.…”