Efficacy and tolerability of intravenous valproic acid in acute adolescent migraine

Objective.-To describe the efficacy and tolerability of rapid intravenous valproic acid (VPA) infusions in children with severe migraine headache. Background.-Intravenous VPA is an emerging treatment option for acute migraine headache. Adult data suggests both efficacy and tolerability of rapid VPA infusions as abortive therapy, but little data exist in children. Methods.-We conducted a retrospective chart review of all children who received intravenous VPA at The Children's Hospital Headache Clinic during an 18-month study period. Baseline intensity of headache pain, time at which maximum relief was attained, pain reduction following therapy, dose and duration of VPA infusion(s), patient's pulse, blood pressure, respiratory rate, and pulse oximetry were collected. Adverse events were also recorded. Results.-Thirty-one children (age = 15 +/- 2 years; 81% female) requiring 58 clinic visits and 71 VPA infusions were included. Most visits (n = 45; 78%) resulted in only one dose of VPA (976 +/- 85mg infused over 12 +/- 4 minutes) for desired pain relief. Percent pain reduction in those children was 39.8%, with time to maximum relief of 63 +/- 31 minutes. Some children required a second dose of 500 mg (n = 13 visits; 22%), that was infused over 14 +/- 6 minutes and produced a 57% reduction in pain intensity from baseline. VPA infusions were well tolerated. Adverse events described included cold sensation (1), dizziness (3), nausea (1), possible absence seizure (1), paraesthesia (2), and tachycardia (2). Conclusions.-Rapid infusion of intravenous VPA is generally well tolerated and may play a role in the management of children with acute migraine headache. Prospective, controlled trials to further investigate this treatment in children are warranted.