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

Clinical Response to Valproate in Patients with Migraine

• Ichikawa M
• Katoh H
• Kurihara T
• Ishii M

• KMID: 2385112
• DOI: http://doi.org/10.3988/jcn.2016.12.4.468

Abstract

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.

Keyword

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

MeSH Terms

Depression
Headache
Humans
Hyperlipidemias
Logistic Models
Medical Records
Migraine Disorders*
Odds Ratio
Rhinitis, Allergic, Seasonal
Risk Factors
Valproic Acid*
Valproic Acid

Figure

• 

  Fig. 1 Distribution of patients according to the predictive index (PI) for the response to valproate in patients with migraine. The PI for the clinical response to valproate was calculated as follows: PI=2×hyperlipidemia (yes)+1×hay fever (yes)+1×depression or other psychiatric disorder (yes). The index was significantly higher for inconsistent responders (IRs) than for consistent responders (CRs; 1.46±1.10 vs. 0.69±0.74, p<0.001).

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