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Combined therapy for migraine prevention? Clinical experience with a β-blocker plus sodium valproate in 52 resistant migraine patients


Dr Julio Pascual, University Hospital Marqués de Valdecilla, 39008 Santander, Spain. Tel. + 34 9 4220 2707, fax + 34 9 2420 2655, e-mail


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The aim was to explore whether combining a β-blocker and sodium valproate could lead to an advantage in efficacy in patients with migraine previously resistant to the two medications in monotherapy. Fifty-two patients (43 women) with a history of episodic migraine with or without aura, and previously unresponsive to β-blockers and sodium valproate in monotherapy, were treated with a combination of propranolol or nadolol and sodium valproate in an open-label fashion. Eight patients (15%) discontinued due to adverse events. Fifteen (29%) did not respond. The remaining 29 cases (56%) showed response (>50% reduction in migraine days). The response was excellent in nine (17%). From this open trial, combination therapy with a β-blocker and sodium valproate appears to be a good migraine preventative in some previously resistant migraine cases. Controlled trials are now necessary to determine the true advantage in efficacy of this combination in difficult to treat migraineurs.