An analysis of the "carry-over effect" following successful short-term treatment of transformed migraine with divalproex sodium.

Abstract

To determine whether successful short-term prophylactic treatment of transformed migraine may be followed by a continued respite from headaches once the treatment has been discontinued ("carry-over effect"). The optimal duration of prophylactic treatment for pervasive headache and for migraine, in particular, is unknown. We prospectively evaluated a series of patients with transformed migraine, all of whom were managed according to a uniform treatment protocol involving prophylactic therapy with divalproex sodium for a period not exceeding 12 weeks. All patients reporting a positive treatment response were followed for at least 2 months after the discontinuation of divalproex sodium, and the incidence of the carry-over effect in that group was assessed. A short-term carry-over effect occurred in 12 (60%) of 20 patients, but more sustained relief occurred in only 8 (40%). The successful short-term treatment of transformed migraine with divalproex sodium will often produce a short-term carry-over effect, but this response will be sustained only in a minority of patients.