Researchers reported at the annual meeting of the Association of Children’s Neurology that children with refractory headache syndrome appeared to have some relief after receiving intravenous valproic acid treatment, including hospitalization for 3 to 4 days.
In a retrospective chart review, Sara Pavitt, MD, assistant professor and director of the Pediatric Headache Program at the University of Texas at Austin/Dell Children’s Medical Center found that the treatment “significantly reduced baseline headache intensity and acute medication use.”
“About two-thirds of patients report improvement in at least one area-headache intensity, acute medication use, and headache frequency,” said Dr. Pavitt Neurology Today in a meeting.
Dr. Pavitt explained that the median of previous preventive trials in this trial was 7 and added that most patients had taken dihydroergotamine and did not respond.
“For this incredibly refractory population, I want to say that we have indeed achieved quite good success,” she said. “We have seen a reduction in the pain score of about 1 point, and we believe this will improve function.”
She said that the number of days of headaches had decreased, but the decrease was not statistically significant.
“We use this as a preventive strategy,” Dr. Pavitt said. “If the prevention strategy doesn’t work, we will send them to the hospital when they are admitted as planned. We tell them that we don’t want this treatment to bring them pain relief in the hospital. We have a regular period of six to eight weeks after admission. Pain assessment during follow-up.”
“We soaked their brains with valproate, and then after a week of treatment, we started to give them a new preventive agent in the outpatient clinic, Dr. Pavitt explained. “We think the new infusion has a synergistic effect and starts to help them. Moving in a new direction, she said, adding that the new preventive agent is determined by the primary care physician.
For the review, Dr. Pavitt of the University of California, San Francisco and her colleagues who are completing the residency carefully examined hospital records dating back to 2017 to determine 45 patients who needed C due to chronic migraines, new daily persistent headaches Children with valeric acid, or persistent post-traumatic headaches. Thirty-seven were girls; eight were boys; 39 complained of chronic migraine; 5 reported new persistent headaches every day, and 1 child received treatment for persistent post-traumatic headaches.
Dr. Pavitt said that the average age of the children in the study was 16 years old, but the age of the children treated ranged from 9 to 18 years old.
Once the children are deemed eligible for treatment, they are admitted to the hospital and given a loading dose of 15 mg/kg in a 30-minute intravenous infusion, up to 3000 kg. After that, they took 5 mg/kg every six hours for a total of 13 doses. Five of the patients reported side effects of nausea, fatigue, dizziness, and anxiety during the infusion. One patient discontinued the medication due to anxiety during the infusion.
“There are no serious side effects,” said Dr. Pavitt. “Repeat intravenous sodium valproate infusion may be a safe and effective treatment for pediatric patients with chronic headaches that are ineffective against a variety of oral and alternative intravenous therapies. patient.”
Dr. Pavitt said the use of valproate in these groups of children requires prospective studies.
Commenting on this study, Andrew Hershey, MD, PhD, FAHS, FAAN, Chairman and Director of Neurology and Professor of Pediatrics and Neurology at Cincinnati Children’s Hospital Medical Center, said: “Intravenous valproate has been used to treat acute diseases for nearly 20 years. Years. Treat severe headaches caused by migraines in emergency departments and hospital settings. After standard care has failed, it is usually given as a single intravenous injection. However, few studies have been well controlled to prove efficacy.”
“The effects of repeated intravenous valproate on headaches caused by migraines that last longer than 24 hours or that have failed home therapy have been largely rumored,” Dr. Hershey said. “Standard care is dopamine antagonists, such as intravenous prochlorperazine and intravenous metoclopramide plus ketorolac and other non-steroidal anti-inflammatory drugs. If it doesn’t work, the next step is intravenous dihydroergotamine. If it doesn’t work , Then every 8 intravenous injections of dihydroergotamine are admitted to the hospital. The goal is to relieve headache or return to baseline.”
He said that in the current treatment plan, if DHE is intolerable or ineffective, valproate is a second-line to third-line treatment, and as better treatment methods enter the clinic, its use may be gradually reduced. This research may suggest a bridge until then.
Dr. Pavitt revealed that her father was employed by Lundbeck as the director of neurology.
Link for more information:
CNS Abstract 42: Pavitt S, Gelfand AA, Allen I, and others. Efficacy and safety of intravenous sodium valproate in children with refractory chronic headache: a retrospective study.