An approach to treating migraine with the anticonvulsant, divalproex sodium, is reviewed from the Comprehensive Headache Center, Germantown Hospital, Philadelphia, PA. Four double-blind, placebo-controlled studies have confirmed the efficacy of valproate in treatment of migraine. The frequency of attacks as well as the duration and intensity were reduced. The most frequent adverse effects included nausea, asthenia, dyspepsia, dizziness, somnolence, and diarrhea. The use of valproate for headache prevention in children under 10 years should be avoided, except in exceptional cases. [1]

COMMENT. The occurrence of liver toxicity in children treated with valproate, between 1:500 to 1:9000, prompts caution since the reaction may be fatal. Attention to possible dietary factors in the cause of migraine, and the initiation of less toxic medications or alternative treatments should be investigated thoroughly before resorting to valproate therapy.

The acute treatment of migraine with Rizatriptan vs Sumatriptan has been studied in 10 US and 4 Dutch investigator centers, involving 449 patients, and is reported from the Department of Neurology, Leiden University Hospital, the Netherlands [2]. The antimigraine effect of 10 and 20 mg rizatriptan was superior to placebo, and equal to 100 mg sumatriptan succinate; 40 mg rizatriptan was superior to 100 mg sumatriptan succinate in efficacy but caused frequent side effects.