Valproate shows promise as acute treatment for migraine

NEW YORK (Reuters Health) – IV valproate appears to be a safe and effective alternative to dihydroergotamine/metoclopramide (DHE/MCLP) for the acute treatment of migraine, according to a recent report.

While valproate is known to prevent migraine, its ability to relieve acute migraine has not been established. However, because this drug lacks cardiovascular side effects and does not interact with triptans or ergotamines, valproate could be particularly useful in the acute setting.

Dr. Keith R. Edwards and colleagues, from the Western New England Pain and Headache Center in Bennington, Vermont, randomized 40 patients with migraines of 24 to 96 hours' duration to receive IV valproate or IM DHE/MCLP.

At 1, 2, 4, and 24 hours following treatment, 50%, 60%, 60%, and 60% of valproate-treated patients reported headache improvement, respectively. The improvement rates were similar in the DHE/MCLP group with the exception of 90% of patients who reported improvement at the 24-hour time point. The groups did not differ significantly in the percentages of patients experiencing nausea, photophobia, and phonophobia.

While no drug-related side effects were tied to valproate therapy, 15% of DHE/MCLP-treated patients experienced nausea and diarrhea within the first 4 hours of treatment, the authors note in the November/December issue of Headache: The Journal of Head and Face Pain.

"Our results suggest that IV valproate is as safe and effective as IM DHE/MCLP for the acute treatment of prolonged migraine headache," the investigators state. However, headache relief was less likely to be sustained at 24 hours with valproate than with DHE/MCLP. Despite this, Dr. Edwards' group concludes that further studies of IV valproate for acute migraine are warranted

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