Abstract
Migraine is a common and burdensome neurological condition which affects mainly female patients during their childbearing years. Valproate has been widely used for the prophylaxis of migraine attacks and is also included in the main European Guidelines. Previous (2014) European recommendations on limiting the use of valproate in women of childbearing age did not achieve their objective in terms of limiting the use of valproate in women of childbearing age and raising awareness regarding the hazardous effect of valproate to children exposed in utero. The teratogenic and foetotoxic effects of valproate are well documented, and more recent studies show that there is an even greater neurodevelopmental risk to children exposed to valproate in the womb. The latest 2018 European review from the European Medicines Agency, with the active participation of the European Headache Federation, concluded that not enough has been done to mitigate the risks associated with in utero exposure to valproate. The review called for more extensive restrictions to the conditions for prescribing, better public awareness, and a more effective education campaign in migrainous women.
Highlights
Migraine, gender and evolution to chronicityMigraine is one of the most common non-communicable diseases, ranked as the most debilitating disease worldwide in under 50s by the Global Burden of Diseases 2016 [1, 2]
Educational measures are necessary in order to ensure that both the clinical community and patients are informed about the risks of valproate in pregnant women and women of childbearing age, and about the measures necessary to eliminate the risk of exposure on valproate in pregnancy
Valproate has a place in the pharmaceutical armamentarium for the prophylaxis of migraine attacks, according to several clinical guidelines
Summary
Gender and evolution to chronicityMigraine is one of the most common non-communicable diseases, ranked as the most debilitating disease worldwide in under 50s by the Global Burden of Diseases 2016 [1, 2]. The results of the French study provided evidence that, despite the measures recommended following the European review in 2014, exposure of women of childbearing age to valproate had persisted in the country in the reported period including a high level of exposure during pregnancy (2 in 1000 pregnancies were exposed to valproate between 2007 and 2014).
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