Download IV Valproate Sodium for Status Migrainosus in the Clinic

IV Valproate Sodium for Status Migrainosus in the Clinic
Jane Cagle, LVN, Stephanie Hall, BS, MPH
Virginia Scott-Krusz, John Claude Krusz, PhD, MD
Abstract____________________________________
Introduction: We have previously shown efficacy of intravenous
valproate sodium in the treatment of migraine headaches. The
principal objective of this study was to look in greater detail at our
published clinical data (Krusz, et al., 2001) to examine the effects of
IV valproate sodium on patients whose migraines fit the criteria for
status migrainosus. By definition, these are a more difficult type of
migraine to treat.
Method: Retrospective chart review was done of patients successfully
treated with IV valproate sodium for migraines. 23 patients (8=M,
15=F) were identified who fit the HIS criteria for status migrainosus.
Average duration of migraine was 82.2 hours. All patients were treated
in a headache clinic during the status migrainosus episode with IV
valproate; no other medications were given. Headaches were rated on
a 0 to 10 scale by patients. Valproate sodium was given 100 mg every
5 minutes.
Results: reduction in migraine headache was 84.6%. Migraines were
8.35/10 prior to treatment and 1.26/10 after. Average dose of
valproate sodium was 1,017 mg over 73.5 minutes. 13 of 23 patients
treated (57%) rated their migraines as 0/10 after treatment;
remaining patients had residual migraine rated as 2.9/10 in severity.
Only two had less than a 50% reduction in severity.
Conclusion: IV valproate sodium is highly efficacious and safe as an
abortive therapy for status migrainosus in the headache clinic. Our
results strongly suggest that hospitalization is not needed. Doubleblind studies are definitely warranted.
Results_________________________________________
In our patients, reduction in migraine headache was 84.6%. Migraines
were 83.5/10 prior to treatment and 1.26/10 after.
Average dose of valproate sodium was 1,017 mg over 73.5 minutes
(range 500-1,750 mg). 13 of 23 patients treated 957%) rated their
migraines as 0/10 after treatment; remaining patients had residual
migraine rated, on average, as 2.9/10 in severity. Only two had less
than a 50% reduction in severity of all patients with status
migrainosus.
The majority of patients reported a moderate to complete reduction of
their nausea and photophobia in tandem with the eradication of their
migraine, headache. Many patients stated that they felt “really
peaceful and well” at the conclusion of treatment and some returned
to work from the clinic. More than half of the patients (n=17) did not
have any headache on the day following treatment with valproate
sodium.
R e d u c t io n in M ir g a in e H e a d a c h e s
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Introduction_____________________________________
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Valproate sodium has been used extensively for migraine prophylaxis
in the last few years and has FDA approval for this purpose. Recently,
an IV form of this medication has been marketed (Depacon, Abbott
Laboratories) and is primarily used for the treatment of seizures.
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N R S 0 to
1 0 S c a le
As an outpatient headache clinic, we are very treatment intensive and
use many intravenously administered medications to abort ongoing
headaches. It is always of interest for us to find new treatment
approaches for patients who are suffering from migraines and other
headaches.
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We have published data on IV valproate sodium in the treatment of
intractable migraines in the headache clinic. This report is a
retrospective review of our treated patients from this publication who
were successful treated for HIS-criteria status migrainosus. Status
migrainosus is defined as unremitting migraine for more than 72 hours
of headache-free time at any point.
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B e fo r e a n d A fte r V a l p o r a te
Conclusions_________________________________________
Methods__________________________________________
Retrospective chart review was done of patients previously
successfully treated with IV valproate sodium for migraines. 23
patients (8=M, 15=F), of the 85 originally reported on, were identified
who fit the HIS criteria for status migrainosus, as stated above.
Average duration of migraine was 82.2 hours. All patients were treated
in a headache clinic during the status migrainosus episode with IV
valproate sodium; no other medications were given. Headaches were
rated on a 0 to 10 numeric rating scale (NRS) by patients at the
beginning of the treatment and its numerous intervals during
treatment. After placement of an IV line antecubitally, valproate
sodium was given 100 mg every 5 minutes intravenously, as a bolus
injection. Headache severity, as well as nausea, photophobia and
phonophobia were rated by each study patient every 10-15 minutes.
No other medication was given at any time during treatment with
valproate sodium. Some patients had treated their intractable
migraines as little as 2-3 hours prior to coming for treatment in the
clinic (e.g., opiates, triptans, DHE45, etc).
This retrospective study of patients with status migrainosus treated
with IV valproate sodium is the first of its kind in the literature,
especially in a headache clinic setting. It is our opinions that even a
very difficult migraine disorder like status migrainosus, which often
requires hospitalization, is treatable in a clinic situation.
The results of this preliminary study suggest that valproate sodium,
used intravenously, is a very effective abortive agent for migraine
headaches that have not responded to usual methods of treatment at
home. Our setting, a headache clinic, is appropriate for emergency
treatment of ongoing migraines, although this treatment approach
could be used in any emergency room.
This study enhances the armamentarium of available intravenous
agents for the acute treatment of intractable migraine headache.
Valproate sodium is effective both as a prophylaxis medication and as
an acute abortive therapy for status migrainosus, one of the most
difficult migraine syndromes to treat.
Reference_______________________________________
Headache Quarterly, 2001, 12:39-41
John Claude Krusz, PhD, MD
Email: [email protected]
Poster presentation supported by Abbott Laboratories