Intravenous sodium valproate aborts migraine headaches rapidly

Shahien, Radi; Saleh, S. A.; Bowirrat, A.

doi:10.1111/j.1600-0404.2010.01394.x

Cited by 50 publications

(28 citation statements)

References 54 publications

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“…Krusz suggests that intravenous therapy may help in breaking a long, unremitting cycle of CDH. Intravenous sodium valproate is one of the safest intravenous drugs used for the various headache disorders and its effects have been demonstrated in both intractable acute attack and chronic daily headaches [19–21]. In one open-label study, intravenous valproate was effective in a number of primary headache disorders (including CDH) [21].…”

Section: Discussionmentioning

confidence: 99%

Refining clinical features and therapeutic options of new daily persistent headache: a retrospective study of 63 patients in India

et al. 2012

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The aim of this retrospective study was to provide data on the clinical features and treatment outcomes of patients with NDPH (fulfilling Kung et al.’s criteria). A total of 63 patients were observed during a 5-yr period (2007–2012). More than one-third (35 %) patients had migrainous features; 65 % patients fulfilled the ICHD-II criteria. Both groups were similar in most clinical and epidemiological features. However, migrainous features were more common in patients with a prior history of episodic migraine (though statistically not significant). After a median follow-up of 9 months, 37 % patients showed “excellent” response (no or less than 1 headache per month). Another 30 % patients had “good” response (>50 % reduction in headache frequency or days per month). Excellent response was more in patients with a history of less than 6 months duration (statistically not significant). Patients with a recognized trigger showed better prognosis. Response was better in patients who received intravenous therapy of methyl prednisolone and sodium valproate. We suggest prospective and controlled studies to confirm our observations.

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Section: Discussionmentioning

confidence: 99%

Refining clinical features and therapeutic options of new daily persistent headache: a retrospective study of 63 patients in India

et al. 2012

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“…However, in a recent report [8] i.v. sodium valproate was found to be effective in acute migraine treatment.…”

Section: Discussionmentioning

confidence: 99%

“…sodium valproate was found to be effective in acute migraine treatment. Valproate has several mechanisms of action that explain its anti-migraine effects, including the increase of γ-aminobutyric acid (GABA) levels in the brain and the reduction of firing rates of serotonergic cells in dorsal raphe [8]. Interestingly, findings of another recent study [9] suggested that valproate might have beneficial effects in CADASIL via cytoprotective effects on vascular smooth muscle cells.…”

Section: Discussionmentioning

confidence: 99%

Rapid improvement of a complex migrainous episode with sodium valproate in a patient with CADASIL

Martikainen

Roine

2011

J Headache Pain

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Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited disease of small arteries caused by mutations in the Notch3 gene. Complex migrainous episodes, such as acute confusional migraine, status migrainosus with persisting aura, and “CADASIL coma” have been described in patients with CADASIL. However, there are few descriptions of effective treatment of such episodes. We describe a 44-year-old male with CADASIL, who presented with sudden-onset aphasia and decreased responsiveness after prolonged, severe migraine attack. Subsequently, the patient had two generalized seizures. A subtle status epilepticus was suspected because of drowsiness and seizures, and intravenous sodium valproate medication was initiated. EEG recording showed left hemispheric attenuation but no spike discharges, thus not confirming epileptic mechanism. The clinical status of the patient improved markedly after the initiation of valproate. The patient started speaking again; drowsiness and headache subsided. In repeated EEG recording, the left hemispheric attenuation disappeared. Diffusion weighted MR imaging showed no signs of recent ischemic events. The patient recovered fully from the episode with no further seizures. We suggest that CADASIL patients with acute complex migrainous episodes may benefit from intravenous sodium valproate.

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“…Avraham et al 12 reported a case of a young girl with a first episode of ACM that was responsive to valproic acid (VPA) during the acute confusional phase and intravenous VPA was suggested as an effective drug. In one of the preliminary studies carried out, Shahein et al 13 concluded that intravenous sodium valproate was found to be safe and rapidly effective for intractable migraine attack. Intravenous sodium valproate has resolved the symptoms in our patient and no recurrence has been found on successive follow-up.…”

Section: Discussionmentioning

confidence: 99%

Acute confusional migraine: a variant not to be missed

et al. 2013

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A middle age woman who had frequent migraines was admitted with memory loss following severe unilateral headache, restlessness and confusion. Investigations including haematology, biochemistry, cerebrospinal fluid analysis serology and imaging were normal. As she had frequent migraines with a history of ophthalmoplegic migraine, acute confusional migraine was thought of as a possibility. The patient responded dramatically to intravenous sodium valproate. We report this case to emphasise that acute confusional migraine, a rare variant of migraine, is occasionally encountered in adults and prompt recognition will lead to appropriate management.

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Intravenous sodium valproate aborts migraine headaches rapidly

Abstract: Intravenous Sodium Valproate (iVPA) seems to be safe and rapidly effective for intractable migraine attack. Randomized, double-blinded, controlled studies are warranted.

Cited by 50 publications

References 54 publications

Refining clinical features and therapeutic options of new daily persistent headache: a retrospective study of 63 patients in India

Refining clinical features and therapeutic options of new daily persistent headache: a retrospective study of 63 patients in India

Rapid improvement of a complex migrainous episode with sodium valproate in a patient with CADASIL

Acute confusional migraine: a variant not to be missed

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