Sodium Valproate versus Amitriptyline in the Prophylactic Treatment of Migraine

Journal of National Institute of Neurosciences Bangladesh Pub Date : 2022-02-06 DOI:10.3329/jninb.v7i2.58100

Shahjada Mohammad Dastegir Khan, S. Walida, Abul Kalam Mohammed Shoab, Muhammad Abdul Momen Khan, Sakhawat Hossain, Md Shaheen Wadud, K. Hossain

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Abstract

Background: Drug prophylaxis of migraine is a safe and effective way of reducing the attack of headache frequency and the economic burden of migraine. Several drugs have been shown to be efficacious in double-blind placebo-controlled trials. Many patients avoid the regular intake of prophylactic drugs because of fear about the side effects, tolerance and addiction. Another reason for the low acceptance of migraine prophylaxis is that the efficacy of most drugs is limited and the burden of treatment cost. In this study two effective drugs, Amitriptyline and Sodium valproate are evaluated regarding their safety and efficacy. This study shows the comparative effectiveness, safety of both drugs and withdraw all the misconception about the prophylactic treatment of migraine among the patients and improve their life style adjustment and reduce the economic burden of the society. Objective: The purpose of the present study was to observe and compare the efficacy of Sodium Valproate and Amitriptyline in the prophylactic management of migraine patients. Methodology: This experimental study was carried out in the Department of Neurology at Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh during the period from January 2013 to December 2013. A total of 120 patients with migraine were selected of which 60 were treated with Amitriptyline (Group-A) and another 60 were treated with Sodium Volproate (Group-B). Both groups were observed for 6 months and the improvement of headache regarding frequency, severity and duration of episodes of headache was recorded in every 2 months follow up. Adverse effect of the drugs also monitored in both group. Result: Out of 120 patients the mean age was 32±8.64years and 34.23±8.09 in group-A and group-B respectively (p=0.147). There were 23 (38.3%) male and 37 (61.7%) female in group-A; whereas 17 (28.3%) male and 43 (71.7%) female in group-B (p=0.245). Thus the study was an age and sex matched study. It was observed that one third 20(33.3%) patients were house wife’s in group-A and 24(40.0%) in group-B. The difference was not statistically significant (p>0.05) between two groups. Frequency of attack per month before treatment was 6.25±5.21 in group-A and 7.80±4.1 in group-B. Frequency of attack per month after 2 months treatment was 4.30±4.14 and 6.19±4.10 in group-A and group-B respectively. Frequency of attack per month after 4 months treatment was 3.78±2.53 in group-A and 4.89±2.83 in group-B. Frequency of attack per month after 6 months treatment was 1.70±1.42 in group-A and 3.1±1.98 in group-B. Frequency of attack per month after 2, 4 and 6 months treatment was statistically significant (p<0.05) between two groups. It was observed that majority (88.3%) patients were improved headache in group-A and 23(38.3%) in group-B. The difference was statistically significant (p<0.05) between two groups. Conclusion: The pain intensity score is significantly decline in patients who received amitriptyline after treatment and almost similar in patients who received sodium valproate. Improved headache most of the patients who received Amitriptyline and less adverse effects developed in this group. Amitriptyline is more effective, seems to be safer than Sodium Valproate. Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 126-131

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丙戊酸钠与阿米替林预防性治疗偏头痛的比较

背景:偏头痛药物预防是减少偏头痛发作频率和减轻偏头痛经济负担的一种安全有效的方法。在双盲安慰剂对照试验中，有几种药物被证明是有效的。由于担心副作用、耐受性和成瘾性，许多患者避免定期服用预防性药物。偏头痛预防接受度低的另一个原因是大多数药物的疗效有限和治疗费用的负担。本研究对阿米替林和丙戊酸钠两种有效药物的安全性和有效性进行了评价。本研究显示了两种药物的相对有效性和安全性，消除了患者对偏头痛预防治疗的所有误解，改善了患者的生活方式调整，减轻了社会经济负担。目的:观察和比较丙戊酸钠与阿米替林对偏头痛患者的预防治疗效果。方法:本实验研究于2013年1月至2013年12月期间在孟加拉国达卡萨里穆拉爵士医学院和米特福德医院神经内科进行。选取120例偏头痛患者，其中阿米替林组60例，丙戊酸钠组60例。两组均观察6个月，每2个月随访记录头痛发作频率、严重程度和持续时间的改善情况。同时监测两组药物的不良反应。结果:120例患者中，a组平均年龄为32±8.64岁，b组平均年龄为34.23±8.09岁(p=0.147)。a组男性23例(38.3%)，女性37例(61.7%);b组男性17例(28.3%)，女性43例(71.7%)(p=0.245)。因此，这项研究是一个年龄和性别匹配的研究。a组20例中有1 / 3(33.3%)为家庭主妇，b组24例(40.0%)为家庭主妇。两组间差异无统计学意义(p>0.05)。治疗前每月发作次数a组为6.25±5.21次，b组为7.80±4.1次。治疗2个月后，a组每月发作次数为4.30±4.14次，b组为6.19±4.10次。治疗4个月后，a组每月发作次数为3.78±2.53次，b组为4.89±2.83次。治疗6个月后每月发作次数a组为1.70±1.42次，b组为3.1±1.98次。治疗2、4、6个月后，两组患者每月发作次数比较，差异均有统计学意义(p<0.05)。结果显示，a组大部分患者(88.3%)头痛得到改善，b组23例(38.3%)头痛得到改善。两组间差异有统计学意义(p<0.05)。结论:阿米替林治疗后疼痛强度评分明显下降，丙戊酸钠治疗后疼痛强度评分基本相同。该组大多数接受阿米替林治疗的患者头痛得到改善，不良反应较少。阿米替林更有效，似乎比丙戊酸钠更安全。孟加拉国国家神经科学研究所杂志，2021年7月，第7卷，第2期，第126-131页

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Journal of National Institute of Neurosciences Bangladesh

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