Clinical Response to Valproate in Patients with Migraine

J Clin Neurol. 2016 Oct;12(4):468-475. doi: 10.3988/jcn.2016.12.4.468.


Background and purpose: Valproate is used as a prophylactic drug for migraine, but it is not be effective in all patients. We used medical records to investigate which clinical factors affected the response to valproate in patients with migraine as an original headache, and established a scoring system for predicting the clinical response to prophylactic therapy.

Methods: We investigated clinical factors from the medical records of 95 consistent responders (CRs) and 24 inconsistent responders (IRs) to valproate.

Results: Multivariate stepwise logistic regression analysis revealed that a history of hyperlipidemia and hay fever and the complication of depression or other psychiatric disorder were significant factors that independently contributed to a negative response, with odds ratios of 6.024 [no vs. yes; 95% confidence interval (CI)=1.616-22.222], 2.825 (no vs. yes; 95% CI=1.046-7.634), and 2.825 (no vs. yes; 95% CI=1.052-7.576), respectively. A predictive index (PI) of the clinical response to valproate in patients with migraine was calculated using the regression coefficients of these three factors as an integer, and the index was significantly higher for IRs than for CRs (1.46±1.10 vs. 0.69±0.74, mean±SD, p<0.001).

Conclusions: The obtained PI may represent an appropriate scoring system for predicting the responses in these patients.

Keywords: clinical response; depression; hay fever; hyperlipidemia; migraine; prophylaxis; risk factor; valproate.