Should women of childbearing age with migraines use valproate?

Title: Valproate use in migraine prevention in women of childbearing age - Why are we still discussing it?
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Dr Anna Andreou
Published: 2018/12/18
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European Headache Federation (EHF) and European Medicines Agency (EMA) published their latest clinical recommendations on migraine prevention in women of childbearing age in
.
, as well
members of the Advisory Board, briefed on the current challenges of migraine prevention and why valproate should be used with caution in women of childbearing age.。 Migraines are incurable, but preventive treatment can usually reduce the intensity and frequency of headache attacks in patients with frequent or chronic migraines. The preferred first-line preventive drugs include isotope, anticonvulsants and b-blockers. If the preferred treatment is ineffective, injections of Botulinum toxin or stronger pillow nerve blocking can also have good results. Propionate and its derivatives, such as sodium dipropate, have been approved by the FDA for the treatment of epilepsy, and some European countries have also used propylene acid for migraine prevention.
treatment for migraines has entered an exciting new era, and we have new migraine prevention drugs. Monoclonal antibodies to anticalcullin gene-related peptides, a small molecular protein thought to be associated with migraines, offer new hope for patients and clinicians. Others are more likely to use non-drug methods. Non-invasive neuromodulation techniques, such as single-pulse transcranial magnetic stimulation and ecstic nerve stimulation, have made considerable progress in therapeutic research, especially in patients where oral preventive drugs and injection therapy are ineffective or insatiable.It's not easy to choose the right treatment for each patient because we need to consider efficacy, side effects, treatment compliance, and often costs and reimbursements. Side effects lead to therapeutic compliance often limit the application of oral preventive therapy. Guidelines for treatment pathways specifically for migraine sufferers in many countries. Non-drug treatment should be preferred when pregnant and lactating women are involved.clinical trials have found that valproate can effectively reduce the frequency, severity and duration of migraine attacks in nearly 40% of patients, so valproate has been approved for preventive treatment of migraines. A double-blind cross-test compared the efficacy of topiramate and valproate, and showed that both drugs reduced the frequency, intensity and duration of headaches.
latest clinical studies in the United States have mainly compared the efficacy of alternative therapy with propylene acid, and the results show that valproate is still an effective preventive treatment to reduce the frequency of migraine attacks. Valproate is not a first-line treatment for migraine prevention, but clinical experience and published case series have demonstrated the role of valproate in the treatment of foretrial migraines and precursor migraines, including paraplegic migraines, migraines with complex sensory motor precursor, post-traumatic headaches with migraine characteristics. Valproate is also used to treat the persistent state of migraines, and randomized controlled studies have shown that valproate can be used to treat headaches caused by overdoses in migraine patients. However, we must take into account the side effects of valproate when using it, including nausea, tremors, hair loss, irregular menstruation, polycystic ovaries and weight gain. The use of valproate in women of childbearing age and pregnancy should be more careful.role of valproate in migraines is not clear. Some of my studies have shown that valproate reduces trigetial brain excitability of triceps of triceps by interacting with GABA energy systems. Although the mechanism of valproate action still has many aspects to be clarified, its effect on the transmission of trigescent nerve pain in the pausc brain has also been confirmed by other studies.
study also showed that valproate was further shown to block cortical propagation inhibition, which is a common migraine precursor model. In other diseases, valproate also has a variety of mechanisms of action, such as interfering with ERK signaling pathline and metabolism of inositol and peanut tetryoleate; These mechanisms may be the cause of valproate's ability to treat spasms, but they may also be the cause of severe birth defects caused by valproate.migraines are a common neurological disorder, with more women than men, especially women of childbearing age. The use of valproate should be prohibited in women of childbearing age and pregnancy, as the drug has been shown to have a clear relationship with neural tube developmental defects, other congenital malformations and cognitive impairments.
found a significant correlation between prenatal use of sodium valproate and lower IQ in children, and that children of women who used sodium valproate were more likely to have communication disorders and memory problems. In addition, children of women who took valproate were five times more likely to develop autism than other children. In addition to potentially mental dyspltrain, valproate may also be associated with growth and development support in children.this consensus was made in collaboration with the European Medicines Agency and the European Headache Federation. This follows the latest review by the Drug Alert and Risk Assessment Committee in 2018, focusing on strengthening risk minimization measures and updating guidelines for the use of propofate in women of childbearing age. In their first review, published in 2014, they recommended limiting the use of valproate in female children, women with fertility potential, and pregnant women, as fetuses exposed to valproate in the womb are at risk of malformation and neurodevelopmental problems.
study of the effectiveness of restrictive orders shows that there is room for improvement after the publication of the restriction recommendations, despite changes in the prescribing behaviour of doctors. For example, a study in France showed that exposure to valproate in women of childbearing age had not changed, with only one third of women using propylene acid in both directions meeting the 2014 recommendation. A survey by the British Epilepsy Society also found that 70 per cent of women who took valproate were unaware of the risks of taking it during pregnancy. Although there is no data on the use of valproate for migraines, it can be speculated that doctors may also have problems prescribing and communicating with patients about the risks of medication.The purpose of this Consensus is to summarize the recommendations of the Drug Alert and Risk Assessment Committee's guidelines for the prevention of migraines with valproate and to detail the measures that clinicians and patients need to take to comply with the guidelines to minimize the use of valproate during pregnancy. The overall goal of the consensus is to reduce the risk of valproate-related neurodevelopment by reducing the use of valproate.consensus article emphasizes that the use of valproate to prevent migraines is a contraindication among women of childbearing age who are pregnant and who do not use contraception. Clinicians can use consensus to teach patients that women on medication should adhere to contraception, and regularly (annually) communicate with patients to assess their personal situation to ensure that they take contraception and are fully aware of the dangers of propylene acid use during pregnancy. At the same time, patients can also use this consensus to understand the recommended recommendations and taboos for sodium valproate at different ages.it is important to understand the changing needs and circumstances of patients at different stages of their lives. While the use of valproate may not pose any risk at one stage, it may not be the case at another. Before treatment begins, patients should be provided with risk information materials to rule out pregnancy and recommend effective contraception. Regular follow-up communication with female patients of childbearing age is equally important, as they may consider giving birth and may even have an unwanted pregnancy, and more importantly, as migraine prevention treatments become more frequent, patients who use valproate may consider replacing more effective and appropriate means. The therapeutic effect of valproate is not significant compared to the risks faced by children of women who use valproate. Therefore, proper communication with female patients who are currently using sodium valproate and regular follow-up can help ensure that patients receive appropriate treatment while minimize adverse effects. 。 (
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) is a peer-reviewed open access journal published under the brand Springer Open. It is specifically dedicated to researchers involved in all aspects of headache and related pain, including theory, methodology, clinical practice and care. The journals scope is broad, reflecting the wide application of scientific advances to every branch of headache and related pain management. Within a multidisciplinary perspective, The Journal of Headache and Pain covers headache and related pain syndromes in the following fields: genetics, neurology, internal medicine, clinical pharmacology, child neuropediatrics, anesthesiology, rheumatology, otology, dentistry, neurotraumatology, neurosurgery, psychiatry, pain management, addiction, public health, and。 epidemiology.
(Source: Science.com)