Edwards K R, Norton J, Behnke M
Western New England Pain and Headache Center, Southwestern Vermont Medical Center, Bennington, VT 05201, USA.
Headache. 2001 Nov-Dec;41(10):976-80. doi: 10.1046/j.1526-4610.2001.01191.x.
To determine the effectiveness and tolerability of intravenous valproate for the acute treatment of migraine headache with or without aura (International Headache Society diagnostic criteria 1.1 and 1.2) compared with intramuscular metoclopramide 10 mg followed 10 minutes later by intramuscular dihydroergotamine 1 mg.
Divalproex sodium is approved for prophylaxis of migraine headache. We studied the possible effectiveness of intravenous sodium valproate for the treatment of acute migraine headache. Valproate offers a treatment option for patients with migraine who recently have used a triptan or dihydroergotamine, theoretically avoiding the risk of drug interactions or cardiovascular complications.
DESIGN/METHODS: In an open-label randomization, patients with an established diagnosis of migraine with or without aura were administered either intravenous valproate or intramuscular dihydroergotamine with metoclopramide to treat moderate-to-severe migraine headache of 24 to 96 hours' duration. Forty patients alternately received either 500 mg intravenous valproate or 10 mg metoclopramide intramuscularly followed by 1 mg dihydro- ergotamine. Patients rated severity of headache and the presence or absence of nausea, photophobia, or phonophobia at baseline, and at 1, 2, 4, and 24 hours.
With intravenous valproate, 50% of patients reported headache improvement from moderate or severe to none or mild at 1 hour following treatment, 60% reported such improvement at 2 hours, 60% at 4 hours, and 60% at 24 hours. Corresponding improvement rates for dihydroergotamine were 45% at 1 hour, 50% at 2 hours, 60% at 4 hours, and 90% at 24 hours. Intravenous valproate and intramuscular dihydroergotamine 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 intravenous valproate experienced drug-related side effects during treatment, 15% of patients who took dihydroergotamine experienced one or more episodes of nausea and diarrhea during the first 4 hours of treatment.
Intravenous valproate is similar in effectiveness to dihydroergotamine/metoclopramide as abortive therapy for prolonged moderate-to-severe acute migraine headache. Although the results were not statistically significant (P =.3635), intravenous valproate appears to offer a safe, effective, and well-tolerated treatment for patients with acute migraine. Relative to dihydroergotamine/metoclopramide, however, headache relief was not as likely to be sustained at 24 hours as with intravenous valproate.
比较静脉注射丙戊酸盐与肌肉注射10毫克胃复安，随后10分钟后再肌肉注射1毫克双氢麦角胺，用于急性治疗伴或不伴先兆的偏头痛（国际头痛协会诊断标准1.1和1.2）的有效性和耐受性。
双丙戊酸钠被批准用于偏头痛的预防。我们研究了静脉注射丙戊酸钠治疗急性偏头痛的可能有效性。丙戊酸盐为近期使用过曲坦类药物或双氢麦角胺的偏头痛患者提供了一种治疗选择，理论上可避免药物相互作用或心血管并发症的风险。
设计/方法：在一项开放标签随机试验中，确诊为伴或不伴先兆偏头痛的患者，接受静脉注射丙戊酸盐或肌肉注射双氢麦角胺加胃复安，以治疗持续24至96小时的中重度偏头痛。40名患者交替接受500毫克静脉注射丙戊酸盐或肌肉注射10毫克胃复安，随后再注射1毫克双氢麦角胺。患者在基线时以及治疗后1、2、4和24小时对头痛严重程度以及是否存在恶心、畏光或畏声进行评分。
使用静脉注射丙戊酸盐治疗后，50%的患者在治疗后1小时报告头痛从中度或重度改善为无或轻度，2小时时为60%，4小时时为60%，24小时时为60%。双氢麦角胺相应的改善率在1小时时为45%，2小时时为50%，4小时时为60%，24小时时为90%。在治疗后的前4小时内，静脉注射丙戊酸盐和肌肉注射双氢麦角胺在缓解相关偏头痛症状（恶心、畏光和畏声）方面效果相似。接受静脉注射丙戊酸盐治疗的患者在治疗期间均未出现药物相关副作用，而接受双氢麦角胺治疗的患者中有15%在治疗的前4小时内出现了一次或多次恶心和腹泻发作。
作为治疗持续中重度急性偏头痛的中止疗法，静脉注射丙戊酸盐的有效性与双氢麦角胺/胃复安相似。尽管结果无统计学意义（P = 0.3635），但静脉注射丙戊酸盐似乎为急性偏头痛患者提供了一种安全、有效且耐受性良好的治疗方法。然而，相对于双氢麦角胺/胃复安，在24小时时头痛缓解的持续性不如静脉注射丙戊酸盐。
