Intravenous valproate sodium in the treatment of daily headache.
BACKGROUND
Treatment of chronic daily headache/transformed migraine is challenging, especially when it is complicated by overuse of analgesics, triptans, or both. One common approach involves the use of repetitive intravenous dihydroergotamine. We investigated the use of intravenous valproate sodium in the treatment of chronic daily headache/transformed migraine in patients who had contraindications to the use of or had failed treatment with dihydroergotamine.


METHODS
We administered intravenous valproate sodium (Depacon) to patients with chronic daily headache/transformed migraine (loading dose 15 mg/kg, followed by 5 mg/kg every 8 hours). All analgesics and triptans were discontinued prior to treatment with divalproex sodium, and preventative medications for migraine were begun or continued. All patients received instruction in behavioral modification and the proper use of analgesics and triptans.


RESULTS
Improvement in headache was reported by 80% of the patients treated, and valproate sodium was tolerated well by most.


CONCLUSIONS
Intravenous valproate sodium may be of assistance in the initial management of patients with chronic daily headache/transformed migraine and analgesic/triptan overuse, especially when dihydroergotamine is ineffective or contraindicated.
Schwartz
Tamara H
TH
Department of Neurology, Washington University, St. Louis, MO 63110, USA.
Karpitskiy
Vladimir V
VV
Sohn
Richard S
RS
D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002524:Cerebellar Ataxia / Q000139:chemically induced; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D004401:Dysarthria / Q000139:chemically induced; D005133:Eye Movements / Q000187:drug effects; D005260:Female; D020773:Headache Disorders / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000139:chemically induced / Q000188:drug therapy*; D016896:Treatment Outcome; D014635:Valproic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D000700:Analgesics; D014635:Valproic Acid