Iv Drug Therapy Relieves Tough-to-Treat Migraine

Reuters - Saturday, August 18, 2001
By Karla Gale

NEW YORK, Aug 17 (Reuters Health) - Giving migraine patients the drug valproate sodium 'rapidly and forcefully' eases severe headaches without side effects, according to a Texas researcher.

Dr. John Claude Krusz of Anodyne PainCare in Dallas treated 85 patients who had experienced no relief after treatment with standard therapies. As he reports in Headache Quarterly, many were in their second or third day of intractable headache.

Patients were given injections of 100 milligrams (mg) of valproate sodium every 5 minutes until their pain was relieved. On average, patients received 720 mg of the drug and achieved maximum pain relief in 50 minutes. Patients' average rating for symptom relief was 88%, and 59 reported complete pain relief. No problems with drowsiness or euphoria were reported, although most patients said they felt very calm after treatment.

"The beauty of it is there's no altered consciousness. Patients can go right back to work," Krusz told Reuters Health. He noted that other investigators have published similar data, but we're a little more aggressive in our dosing, and our percentage results are a little better.

"I've had emergency room docs say they're not comfortable with using (IV valproate)," he commented. "But I've taught doctors at my hospital to use it. I think in another year or two we'll have a much better comfort level with its use."

Krusz pointed out an emerging pattern of behavior on the part of insurance companies that is leading to increased use of emergency departments for treating migraine headaches.

For example, he noted, an insurance company may only allow a less effective drug on their formulary, "even if the price of the more effective drug is within 20 cents of the one that doesn't work. Then they'll cut back and say patients are only allowed so many doses per month," Krusz continued.

"The bean counters don't care how many thousands of dollars it costs for patients to go to the ER, because that doesn't affect what they're accountable for," he added.

source: Headache Quarterly 2001;12:39-41.