The efficacy of divalproex sodium (DVPX, Depakote,) in adult migraine, epilepsy and mood disorder is well-established. This has been less often studied in children and adolescents. The objective of this study is to follow 20 pediatric migraine patients given preventive DVPX.
Methods: Patients were equally divided by gender and ranged in age from 7 to 17 years. Four had migraine with aura. Attacks varied from once to seven times weekly, with daily headache in four patients. Comorbid psychiatric disorders were present in eight (three bipolar, two depression, two attention deficit-hyperactivity, one ADD only, one learning disability, one developmental delay, one oppositional-defiant). Four patients had epilepsy. Other associated conditions were vasodepressor syncope and fibromyalgia. Ten patients had EEGs, five normal and five abnormal, including three of four with seizures.
Results: DVPX doses ranged from 250 to 1125 mg/day. Twelve patients had migraine reduction greater than 50% and three became headache free. Four had side effects requiring discontinuation (two weight gain, one lethargy, one anorexia, one alopecia). Response and headache freedom were more likely with abnormal EEG and comorbid epilepsy, and less likely with psychiatric comorbidity.
Conclusion: DVPX is an effective pediatric migraine preventive,
particularly in patients with other neurological disorders. The expected
efficacy in patients with comorbid mood disorder was not seen, possibly because bipolar disorder in children is less well defined than in adults.