Stillman Mark J, Zajac Deborah, Rybicki Lisa A
Department of Neurology, Division of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Headache. 2004 Jan;44(1):65-9. doi: 10.1111/j.1526-4610.2004.04010.x.
To evaluate the effectiveness of intravenous valproate in managing moderate to severe headaches.
Despite major strides in the understanding of primary headache disorders, there have been few additions to acute headache management other than introduction of the triptans. An intravenous antiepileptic preparation, sodium valproate, has been reported to be effective in the management of status epilepticus and acute headache.
Between March 13, 2000 and October 11, 2000, we prospectively treated, in a nonrandomized and open-label study, every patient with a moderate to severe headache (4 or greater on a visual analog scale of head pain from 1 to 10) who wanted treatment with intravenous valproate. Using a verbal visual analog scale for pain (0 = no headache and 10 = most severe headache), we measured head pain before treatment and at time of discharge. The treating nurse monitored vital signs and side effects. A positive response was defined as a 50% or greater reduction at discharge in baseline pain. Information was collected regarding patient demographics, type of headache (according to criteria of the International Headache Society and that recently proposed for chronic headache), observation time in the treatment suite, cumulative dose of valproate, and use of concurrent medications. Univariable and multivariable correlates of response to treatment were identified using logistic regression analysis.
One hundred thirty treatments were given to 89 women and 17 men, aged 17 to 76 years; 92 patients received only one treatment. Valproate doses ranged between 300 and 1200 mg. Thirty-three patients (31%) presented with episodic migraine, with or without aura; 45 patients (42%) presented with chronic daily headache with a history of episodic migraine, with or without aura (transformed migraine); 22 (21%) with unclassifiable chronic headache; 2 (2%) with episodic cluster headache; and 4 (4%) with chronic tension-type headache. For first treatments only, 61 patients (57.5%) responded to treatment, whereas for all treatments, 82 patients (63.1%) responded. Age and gender did not affect likelihood of response, whereas increasing duration of treatment (P=.003) and the additional use of analgesics (P=.021) were each negatively associated with response. Among headache types, unclassifiable chronic headache segregated from all other classified headaches in terms of poor response. Aside from rare dizziness (n = 2) and one spell interpreted as a pseudoseizure, no side effects were noted.
Intravenous valproate is a safe, rapidly effective, abortive headache agent. It appears to be an effective analgesic for identifiable primary headaches, especially episodic headache, and less effective for unclassifiable chronic headache. Randomized, double-blind, controlled studies are warranted.
评估静脉注射丙戊酸盐治疗中度至重度头痛的有效性。
尽管在原发性头痛疾病的认识方面取得了重大进展，但除了引入曲坦类药物外，急性头痛治疗方面的进展甚微。据报道，一种静脉注射用抗癫痫制剂丙戊酸钠在治疗癫痫持续状态和急性头痛方面有效。
在2000年3月13日至2000年10月11日期间，我们在一项非随机、开放标签的研究中，对每一位有中度至重度头痛（头痛视觉模拟量表评分从1至10，4分或更高）且希望接受静脉注射丙戊酸盐治疗的患者进行了前瞻性治疗。使用疼痛言语视觉模拟量表（0 = 无头痛，10 = 最严重头痛），我们在治疗前和出院时测量了头痛情况。治疗护士监测生命体征和副作用。阳性反应定义为出院时基线疼痛减轻50%或更多。收集了有关患者人口统计学、头痛类型（根据国际头痛协会标准以及最近提出的慢性头痛标准）、在治疗室的观察时间、丙戊酸盐累积剂量以及同时使用药物的信息。使用逻辑回归分析确定治疗反应的单变量和多变量相关因素。
共对89名女性和17名男性进行了130次治疗，年龄在17至76岁之间；92名患者仅接受了一次治疗。丙戊酸盐剂量在300至1200毫克之间。33名患者（31%）表现为发作性偏头痛，有或无先兆；45名患者（42%）表现为有发作性偏头痛病史的慢性每日头痛，有或无先兆（转化型偏头痛）；22名（21%）为无法分类的慢性头痛；2名（2%）为发作性丛集性头痛；4名（4%）为慢性紧张型头痛。仅首次治疗时，61名患者（57.5%）对治疗有反应，而所有治疗中，82名患者（63.1%）有反应。年龄和性别不影响反应可能性，而治疗时间延长（P = 0.003）和额外使用镇痛药（P = 0.021）均与反应呈负相关。在头痛类型中，无法分类的慢性头痛在反应不佳方面与所有其他分类头痛不同。除了罕见的头晕（n = 2）和一次被解释为假性癫痫发作外，未观察到副作用。
静脉注射丙戊酸盐是一种安全、起效迅速的头痛缓解剂。它似乎是一种对可识别的原发性头痛，尤其是发作性头痛有效的镇痛药，而对无法分类
