Antiseizure medications as migraine preventatives: a call for action for a teratogenic and neurodevelopmental risk removal

ABSTRACT

Introduction

A recent study has demonstrated an increased risk of neurodevelopmental disorders, including autism spectrum disorder, in individuals exposed to either valproate or topiramate monotherapy. Regulatory bodies have initiated a review to reassess the safety of topiramate exposure during pregnancy. These novel findings raise concerns regarding the recommendation of antiseizure medications in women of childbearing potential. This manuscript highlights current research defining concerns specific to the use of valproate and topiramate in women of childbearing potential.

Areas covered

This manuscript summarizes recent findings regarding the safety of valproate and topiramate when compared to alternative therapies for the preventative treatment of migraine in women of childbearing potential. The studies included in this review were selected following a comprehensive literature review of multiple relevant databases. All studies that were published within the past 15 years were considered for inclusion.

Expert opinion

The use of valproate and topiramate in women of childbearing potential should be highly discouraged. Our recommendations include a review of current prescribing guidelines, further public education regarding the neurodevelopmental and congenital risks associated with the use of valproate and topiramate, and an appeal for further research defining the safety of alternative medications for migraine prevention when intrauterine exposure is possible.

KEYWORDS:

• CGRP
• migraine prevention
• onabotulinumtoxinA
• topiramate
• valproate

Article highlights

• Intrauterine exposure to antiseizure medications such as valproate and topiramate is associated with neurodevelopmental disorders, including autism spectrum disorder.

• Although the teratogenic and neurodevelopmental risk factors associated with intrauterine valproate exposure have been well established, regulatory bodies are actively reviewing the safety of intrauterine topiramate exposure.

• While the use of valproate and topiramate should be discouraged in women of childbearing potential, little is known regarding the safety of alternative preventative treatments of migraine.

• Valproate and topiramate use should be discouraged in women of childbearing potential, this recommendation should be included in all guidelines discussing the preventative treatment of migraine.

• Further research investigating the safety of alternative preventative treatments of migraine is necessary to determine firm therapeutic recommendations in cases when intrauterine exposure is possible.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contribution statement

All authors have contributed equally to this manuscript. All authors have read and agreed to the published version of the manuscript.

Additional information

Funding

This paper was not funded.