A study on comparison of efficacy of sodium valproate and amitriptyline in the management of migraine
Keywords:
Migraine, Prophylaxis, Amitriptyline, Sodium ValproateAbstract
Introduction: Migraine is a common disabling neurological disorder that affects men and women equally. Frequently recurring, severe, disabling and long-lasting migraine attacks requires long term prophylaxis. The two most common alternatives that are used in the prophylactic therapy is Amitriptyline and Sodium valproate. Hence it is thought worthwhile to study the efficacy and tolerability of sodium valproate vs. Amitriptyline in migraine prophylaxis and find out the best treatment option between the two.
Material & Methods: This Prospective observational study was done in 200 patients; they were enrolled on the basis of inclusion and exclusion criteria. The baseline characteristics of the patients were recorded, along with headache frequency and migraine pain severity before and after treatment were recorded using VAS score. Efficacy was assessed by noting the reduction in number of migraine attacks per month, severity of pain corresponding to the baseline at the end of 3 months and 6 months of treatment. The adverse drug reactions were recorded in ADR form and causality was assessed using WHO Causality assessment.
Results: At the end of 3 and 6 months of treatment, patients in both the groups showed significant improvement in migraine symptoms. Improvement in VAS score at the end of 3 months, 50% and 70% patients showed > 50% improvement in Amitriptyline and sodium valproate group respectively. At the end of 6 months, it was 63% and 82%. Only 40% in Amitriptyline group had developed ADR, whereas in sodium valproate group 67% developed ADR. Maximum number of ADR associated in both groups had possible causal association as per WHO causality assessment scale.
Conclusion: Sodium valproate had better efficacy at the end of 3 months and 6 months of prophylactic therapy. In terms of tolerability profile, amitriptyline was superior in comparison with sodium valproate, during the study period.
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