Repetitive dosing of 250 mg valproate sodium over the course of 4 days is safe, well tolerated, and possibly effective for improving headache pain, intensity, and frequency in patients with chronic migraine, according to a study in Headache.
This retrospective chart review study included adult patients with chronic migraine (n=14) who were admitted for a 4-day course of intravenously administered valproate sodium. Over the course of the treatment period, patients received 250 mg valproate sodium over 60 minutes every 8 hours. The majority of patients received a total of 9 doses, with total doses ranging from 1125 mg to 2250 mg in 13 patients.
Only 1 patient discontinued after the first dose due to an increase in previous symptoms of nausea, vomiting, and vertigo. Only the first admission for therapy in patients with multiple admissions was selected for evaluation. The investigators retrospectively reviewed headache diaries from 1 month prior to, during, and 2 months after admission.
Approximately 69% (n=9) of the patients treated during the entire treatment period had an improvement in their headache following admission. Additionally, these same patients also reported reductions in headache frequency, intensity, and/or use of acute medications approximately 4 to 6 weeks after admission. A smaller proportion of patients (38%) reported improvements in headache intensity during inpatient admission. Stable headache pattern was reported in 62% of patients. Restlessness was reported in 1 patient, but this event improved once infusion time was doubled to 120 minutes.
Limitations of this study include its retrospective nature, small sample size, and relatively short treatment period.
The researchers concluded that a larger study is needed, particularly a study “with the addition of a blinded standard of care and other treatment groups for comparison.”
Riggins N, Ehrlich A, Sawhney H, Dapkus L, Levin M. Retrospective chart review of intravenous valproate sodium as a preventive treatment for patients with chronic migraine. Headache. 2020;60(3):617-620