Pregnant women should not use certain preventive migraine medications because the drugs have been linked to lower IQ scores in children who were exposed to these drugs in the womb, according to the U.S. Food and Drug Administration (FDA). Pregnant women should avoid taking valproate sodium and related medications. Valproate products include valproate sodium (Depacon), divalproex sodium (Depakote, Depakote CP and Depakote ER), valproic acid (Depakene and Stavzor) and their generics.

Q. I have been on Depakote® and amitriptyline for migraines since about 1996. I kept the headaches reasonably under control (I've had them since 1985) with those two preventive medications and lifestyle management (strict diet, regular exercise, enough sleep and decreasing stress). I do, however, have moderately severe arthritis of the neck from a car accident in the 1970s. For the past year, I have had a migraine every day except four intermittent days; I can't figure out what I could be doing wrong. I avoid rebound headaches by alternating my use of Norgesic Forte® with Tylenol 500®, or when necessary, Imitrex® or Amerge®. I'm careful not to take more than the prescribed amount of any medication. My question is this: Would Neurontin® be of help to me? Has Depakote ceased to be effective? Or could the arthritis in my neck have finally won the battle I've been having with it? My neck pain is excruciating at the end of a work day, especially if I've had a headache. Neck pain is one of the precursors to a migraine for me.

Women considering pregnancy should avoid taking valproate (Depakote®) to avoid risks to the developing fetus. A new study reported in the New England Journal of Medicinefound that children whose mothers took valproate for epilepsy during pregnancy had IQs six to nine points lower than children exposed to other epilepsy drugs. Valproate and some other antiseizure drugs are used as migraine preventives, though taken at much lower doses than for the prevention of seizures.

The U.S. Food and Drug Administration approved a generic version of Depakote® extended-release tablets (divalproex sodium) at the end of July. The medication is approved to treat migraine as well as seizures and bipolar disorder. In people with migraine, it is used as a preventive and reduces the frequency and severity of migraine episodes.

The Food and Drug Administration has approved divalproex sodium (Depakote® and Depakote ER) from Abbott Laboratories as a prophylactic medication for migraine headache. However, divalproex sodium is not a new compound. It has been in use since 1983 for treating epilepsy and is also approved as an alternative treatment to lithium for bipolar disorder. Several clinical trials have demonstrated its effectiveness in migraine prevention.