Efficacy and tolerability of valproate versus topiramate in migraine prevention, a randomized controlled multi-center trial

Abstract

Although topiramate and valproate are antiseizure medications that have many contraindications and could produce many side effects, they are still used as migraine preventive therapy in middle- and low-income countries. Several trials compared valproate versus topiramate in patients with migraine showed inconclusive results. We aimed to evaluate the tolerability and efficacy of valproate compared to topiramate in migraineurs from the Middle East and North Africa.

Our single-blinded, multi-centre, randomized controlled trial had two parallel groups: the (A) group, which included 300 patients who received valproate, and the (B) group, which included 300 patients who received topiramate.

In our trial, 574 patients completed the 3-month follow-up period. Topiramate achieved a greater reduction in migraine attack severity on VAS and HIT-6 than valproate to a degree that was statistically significant. 129 (43 %) patients in valproate group and 66 (22 %) in topiramate group had any adverse effects (HR 3.11; 95 % CI 1.08–6.13; P = 0.05), of which 23 patients (7.7 %) in valproate group and twelve patients (4 %) in the topiramate group stopped treatment prematurely due to intolerable adverse effects (HR 2.47; 95 % CI 1.04–5.88; P = 0.04).

We concluded that, in adult patients with migraine, the regular use of topiramate 50 mg Bid for three months yielded significantly higher reductions in migraine attack severity and HIT6 score compared to using valproate 500 mg Bid; valproate led to a significantly higher percentage of patients who prematurely stopped treatment due to intolerable adverse effects.

Trial registration: ClinicalTrials.gov, (NCT06248931)- 08 February 2024.