***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study was conducted to evaluate and compare the efficacy and treatment effect of sodium valprovate with propranolol and tricyclic antidepressive drugs . This piece is a rar and omized clinical trial conducted on 126 migraine patients admitted to brain and nerves clinic in Arak , Iran . Patients were divided in two groups then r and omized to study treatments . Data were gathered using a checklist and a complete examination . They were analyzed by Chi square and exact test . In patients with normal and abnormal encephalogram the effectiveness rate of two treatments were 35 , 61.9 , 95.6 and 28.6 % , respectively . This difference between two treatments was statistically significant ( p<0.001 ) . But did n't observe significant differences between two sex groups ( p>0.05 ) . For treatment and control of the migraine , in patients with normal encephalogram , propranolol with tricyclic antidepressive drugs advised and for abnormal encephalogram sodium valprovate can be the better treatment for management and reduction of headache attacks OBJECTIVE We evaluated the efficacy of  prophylactic valproic acid treatment ( 6 months ) on the frequency of migraine attacks and the number of migraine headache days with respect to serum levels . BACKGROUND Valproic acid , a GABAergic drug , has been shown to be effective for migraine prophylaxis . Results from several dose- and serum level-adjusted studies have recommended valproic acid doses within a range of 500 to 1500 mg per day for migraine prophylaxis . DESIGN AND METHODS In this prospect i ve open-label study , 52 patients received valproic acid doses of 300 to 1200 mg per day ; 45 patients were treated per protocol .  Valproic acid serum levels increased linearly in relation to the valproic acid dose and were between 21 and 107 microg/mL at the end of the treatment period . Patients were divided into two groups : those with valproic acid serum levels less than 50 microg/mL ( group 1 ) and those with serum levels greater than 50 microg/mL ( group 2 ) . RESULTS The frequency of migraine attacks was significantly reduced in group 1 from 3.5 + /- 0.9 to 2.0 + /- 0.9 attacks per month . Migraine headache days also decreased ( 6.4 + /- 3.5 to 4.6 + /- 2.9 days per month ) . In the high serum level group , a reduction of migraine attacks from 3.5 + /- 0.9 to 2.8 + /- 1.0 attacks per month and only a slight decrease in headache days ( 6.4 + /- 3.5 to 6.1 + /- 2.4 days per month ) was observed . The outcome of group 1 ( low serum level ) was significantly better than that of group 2 with respect to both parameters ( P<.05 ) . Side effects were generally mild and temporary . CONCLUSIONS Due to the lack of additional benefit from higher valproic acid doses ( more than 600 mg per day ) , we recommend daily valproic acid doses of 500 to 600 mg with a target serum level less than 50 microg/mL for the prophylactic treatment of migraine We included 43 patients with migraine without aura in a triple-blind , placebo- and dose-controlled , crossover study of the prophylactic effect of slow-release sodium valproate ; 34 patients completed the trial . The number of days with migraine was 3.5 per 4 weeks during treatment with sodium valproate and 6.1 during placebo ( p = 0.002 ) . The severity and duration of the migraine attacks that did occur were not affected by sodium valproate when compared with placebo . Fifty percent of the patients were responders , ie , their initial migraine frequency was reduced to 50 % or less during sodium valproate as compared with 18 % during placebo . The number of responders increased during the trial to 65 % in the last 4 weeks of the active treatment period . There were no serious side effects requiring withdrawal of patients from the study . We conclude that sodium valproate is an effective and well-tolerated prophylactic medication for migraine without aura ABSTRACT The present study was performed to evaluate the efficacy of low-dose topiramate and compare it with sodium valproate that is prevalently prescribed as a migraine prophylaxis . This was a r and omized , double-blind , parallel-group clinical trial on 56 patients who completed the course of study .  Topiramate and valproate were administered at 50 mg/day and 400 mg/day , respectively , during the follow-up period . Frequency , intensity , duration , associated symptoms with headaches , analgesics use , as well as drugs ’ side effects were studied . Participants completed MIDAS and HIT-6 question naires before and after treatment . Frequency , intensity , and duration of migraine headaches as well as MIDAS score and symptomatic medications decreased significantly between repeated follow-up visits in both groups . Responder rate for patients treated with topiramate and valproate were 71.6 % and 64.3 % , respectively , and the difference between the two groups was not statistically significant . The reduction of headache severity in the topiramate group was significantly more than that in the valproate group ( p = .027 ) . During the study , no statistically significant reduction in associated symptoms with migraine were observed in both the groups . Topiramate dose of 50 mg/day with fewer side effects in comparison with its higher doses may be an appropriate substitution for first-line migraine prophylaxis such as valproate OBJECTIVE To compare the efficacy and safety of botulinum toxin type A ( BoNTA ; BOTOX : Allergan , Inc. ) and divalproex sodium ( DVPX ; DEPAKOTE : Abbott Laboratories ) as prophylaxis in reducing disability and impact associated with migraine . BACKGROUND There is a need for effective , well-tolerated prophylactic treatment of migraine . DESIGN / METHODS This was a r and omized , double-blind , single-center prospect i ve study . Fifty-nine patients received either BoNTA 100 U/placebo-DVPX  bid or placebo-BoNTA/DVPX 250 mg bid . BoNTA/placebo injections were given at Day 0 and at Month 3 . Patients were evaluated at Months 1 , 3 , 6 , and 9 . RESULTS Both treatments showed significant improvements in migraine disability scores and reductions in headache days and headache index . A trend to decreased headache severity was observed with BoNTA . A greater percentage of DVPX patients reported adverse events possibly related to treatment ( DVPX 75.8 % vs BoNTA 50 % , P = .04 ) and discontinued because of adverse events ( DVPX 27.6 % vs BoNTA 3.3 % , P = .012 ) . CONCLUSIONS Both BoNTA and DVPX significantly reduced disability associated with migraine ;  BoNTA had a favorable tolerability profile compared with DVPX BACKGROUND AND OBJECTIVES Certain neuromodulators , most notably topiramate ( TPM ) and divalproex sodium ( DVP ) , are effective preventive agents for migraine . Published data from head-to-head studies comparing TPM and DVP are not available . The purpose of this study was to compare TPM and DVP for the prophyaxis of migraine in a " real-world " setting . METHODS At 2 centers and over a period of 12 months we prospect ively evaluated and treated a consecutive series of migraine patients . At baseline all were experiencing less than 15 headache days/month , and we treated all patients requiring prophylactic therapy with either TPM or DVP . We evaluated adherence , headache frequency ( HF ) and tolerability after 3 months of treatment . TPM treatment was initiated at 25 mg daily and increased every 10 days ( 25 mg ) to a target of 150 mg/day ( 2 divided doses/day ) . Treatment with DVP was initiated at 250 mg daily and sequentially titrated up to 500 mg twice daily . All patients were naïve to the use of TPM and DVP . RESULTS One hundred and twenty patients ( 104 women and 16 men of ages 18 to 68 , mean 41.2 years ) were included .  Topiramate selectively was prescribed to 69 patients and DVP selectively to 51 . Baseline HF for both groups was similar ( 8 ± 4 headache days/month ) . By intention to treat analysis at 3 months , 40 ( 58 % ) of patients initially treated with TPM and 26 ( 51 % ) of those initially treated with DVP experienced a reduction in HF of > 50 % ( P = NS ) . Ten patients ( 14.5 % ) initially treated with TPM and 8 ( 15.7 % ) initially treated with DVP did not return for follow up or were begun on alternative prophylactic therapy . The most common side effects manifested by TPM patients were weight loss ( 50 % of those who completed the treatment period ) , paresthesia ( 48 % ) , and cognitive disturbances ( 20 % ) , whereas DVP patients who completed the treatment period reported weight gain , hair loss , and gastrointestinal symptoms ( approximately 24 % for each ) . The mean doses achieved by those completing the study were 140 mg/day for TPM and 890 mg/day for DVP . CONCLUSIONS Although any conclusions from this investigation necessarily are limited because of our study 's open-label nonr and omized design , these results suggest that TPM and DVP are reasonably effective and generally well tolerated when used to treat a " real-world " population of episodic migraineurs who require prophylaxis Objective To evaluate the efficacy and safety of extended-release divalproex sodium compared with placebo in prophylactic monotherapy treatment of  migraine headache .  Methods This was a double-blind , r and omized , placebo-controlled , parallel-group study . Subjects with more than two migraine headache attacks during a 4-week baseline were r and omly assigned in a 1:1 ratio at each center to receive either extended-release divalproex sodium or matching placebo once daily for 12 weeks . Subjects initiated treatment on 500 mg once daily for 1 week , and the dose was then increased to 1,000 mg once daily with an option , if intolerance occurred , to permanently decrease the dose to 500 mg during the second week . Reduction from baseline in 4-week migraine headache rate was the primary efficacy variable . Migraine headaches separated by a < 24-hour headache-free interval were counted as single migraines in calculating migraine headache rates . Tolerance and safety were also evaluated . Results The mean reductions in 4-week migraine headache rate were 1.2 ( from a baseline mean of 4.4 ) in the extended-release divalproex sodium group and 0.6 ( from a baseline mean of 4.2 ) in the placebo group ( p = 0.006 ) ; reductions with extended-release  divalproex sodium  were significantly greater than with placebo in all three 4-week segments of the treatment period . No significant differences were detected between treatment groups in either the overall incidence or in the incidence of any specific treatment-emergent adverse event ; 8 % of subjects treated with extended-release divalproex sodium and 9 % of those treated with placebo discontinued for adverse events . Conclusion Extended-release divalproex sodium is an efficacious , well-tolerated , safe , and easy-to-use once-a-day prophylactic antimigraine medication We assessed the efficacy of sodium valproate as a prophylactic agent in  migraine headache .  A prospect i ve r and omized study was conducted in adult patients who previously derived no significant benefit from most conventional prophylactic therapy for migraine . Twenty-seven patients with a diagnosis of migraine with aura or migraine without aura from a headache clinic received low dose sodium valproate for 3 months . Response to therapy was defined as 50 % or greater reduction in the frequency of headache . Plasma drug level monitoring helped to identify four noncompliers who were excluded from the study . Seventeen ( 71 % ) patients observed improvement within 4 - 6 weeks of medication and remained well for 12 weeks . They were further followed up for 12 - 24 months . Two patients for side effects and 1 for nondrug-related problems were withdrawn from follow-up study . Twelve patients ( 60 % ) maintained their response for 12 months or longer . Clinical improvement ( percentage reduction in the frequency of migraine attacks ) correlated inversely with the plasma drug levels at 13 - 24 months and daily dose of valproate , among the responders , suggestive of a possible therapeutic window . In other words , patients who do not respond to low dose valproate are unlikely to benefit from further increase in dosage The aim of this study was to compare the efficacy and safety of valproate versus flunarizine in migraine prophylaxis in a r and omized double-open clinical trial . Twenty-two migraine sufferers were treated with valproate ( 1 g per day ) for 8 weeks ; a parallel group of 22 migraine sufferers was treated with flunarizine ( 10 mg per day ) . The main admission criterion was a minimum of 3 migraine ( with , or without aura ) attacks per month . The major clinical parameters evaluated were the frequency of headache attacks , the frequency of use of drugs for the acute management of migraine , the patients ' opinion of treatment and the Hamilton anxiety and depression rating scales . During the study 3 patients dropped out ( 1 from the valproate and 2 from the flunarizine groups ) . Fifteen patients ( 71. 
    Output:
    
Valproate is effective in reducing headache frequency and is reasonably well tolerated in adult patients with episodic migraine