SynthesisBMC neurology2026
Prophylactic efficacy and safety of valproate versus topiramate for migraine: a systematic review.
Synthesis in BMC neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMigraine prophylaxis options commonly include valproate and topiramate. Although several randomised trials have directly compared these agents, their relative efficacy and safety remain underexplored. Existing reviews have largely focused on placebo-controlled or indirect comparisons and have not comprehensively synthesised the available head-to-head evidence. This systematic review, therefore, evaluates the comparative efficacy and safety of valproate versus topiramate using a comprehensive, multilingual search
methodsThis review has been registered on the Open Science Framework (DOI: https://doi.org/10.17605/OSF.IO/ZC3S6 ). Databases and registers were searched to 9 September 2025. We included randomised controlled trials (RCTs) comparing valproate with topiramate in adult migraineurs. Due to the high risk of bias, evaluated at the outcome level using the revised Cochrane Risk of Bias 2 tool, a descriptive approach was adopted.
resultsEight trials were included (1659 participants; 72.2% female; mean ages 29.2-42.1 years). Two studies were in Chinese, one in Persian, and the rest were in English. Both drugs appeared to reduce migraine frequency meaningfully. Reductions in migraine duration, pain intensity, and disability measures (HIT-6, MIDAS) improved similarly with both drugs. The evidence base was insufficient to support a definitive efficacy advantage for either drug. Adverse events were common but mostly mild. Valproate use was often associated with increased appetite, drowsiness, and tremor, while topiramate use was commonly associated with paraesthesia and appetite loss.
conclusionsThe head-to-head randomized evidence appears to suggest that both valproate and topiramate may be effective for migraine prophylaxis. However, the current evidence is insufficient to support definitive claims of superiority for either drug. Differences in adverse- event profiles may therefore play a key role in guiding individualised treatment decisions. High- quality, well-powered trials are needed.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.