Headache Drugs Logo
Home | About Dr. Robbins | Archived Articles | Headache Books | Topic Index  

Back to List



Comparison of Intravenous Valproate vs.
Intramuscular Dihydroergotamine and Metoclopramide
for Acute Treatment of Migraine Headache
Edwards KR, Norton J, Behnke M
Posted October 2002
Headache 2001; 41:976-980

Objective:   To determine the effectiveness and tolerability of valproate IV for the acute treatment of migraine headache with or without aura (International Headache Society diagnostic criteria 1.1 and 1.2) compared with metoclopramide 10 mg. IM followed 10 minutes later by dihydroergotamine (DHE) 1 mg. IV.

Results:   With valproate IV, 50 percent of patients reported headache improvement from moderate or severe to none or mild at 1 hour following treatment, 60 percent reported such improvement at 2 hours, 60 percent at 4 hours, and 60 percent at 24 hours. Corresponding improvement rates for dihydroergotamine were 45 percent at 1 hour, 50 percent at 2 hours, 60 percent at 4 hours, and 90 percent at 24 hours. Valproate IV and DHE IM provided similar relief from associated migrainous symptoms (nausea, photophobia, and phonophobia) during the first 4 hours following treatment. While none of the patients who received valproate IV experienced drug-related side effects during treatment, 15 percent of patients who took DHE experienced one or more episodes of nausea and diarrhea during the first 4 hours of treatment.

Conclusions:   Valproate IV is similar in effectiveness to DHE/metoclopramide as abortive therapy for prolonged moderate-to-severe acute migraine headache. Although the results were not statistically significant, intravenous valproate appears to offer a safe, effective, and well-tolerated treatment for patients with acute migraine. Relative to DHE/metoclopramide, however, headache relief was not as likely to be sustained at 24 hours as with valproate IV.