Patient discussions
The initial assessment should provide an insight into the level of patient and family anxiety that might be contributing to symptom perception, and should facilitate the setting of realistic expectations of management.
Before the initiation of treatment, it is helpful to define what will constitute success from a parental/patient perspective: for example, reduction in school absence, number of symptom-free days per month.
Patients may also be advised to avoid any possible triggers, such as cheese and chocolate, if these seem to be associated with their migraines. Establishing whether stress is a contributory factor is also important, and steps to reduce this stress should be taken.
Females of childbearing age must follow a pregnancy prevention programme while on treatment with valproate medicines. For EU countries, the European Medicines Agency states that this programme should include:[46]
An assessment of the patient’s potential for becoming pregnant
Pregnancy tests before starting and during treatment as needed
Counselling about the risks of valproate treatment and the need for effective contraception throughout treatment
A review of ongoing treatment by a specialist at least annually
A risk acknowledgement form that patients and prescribers will go through at each such annual review to confirm that appropriate advice has been given and understood.
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