Effective treatment of acute migrai...

Effective treatment of acute migraine is challenging. Intravenous prochlorperazine has documented efficacy in the management of migraine pain. However, the sedative and extrapyramidal drifts of prochlorperazine can be distressing. not long ago intravenous sodium valproate has been used favorably in some case series and a single prospective investigation Tanen and associates conducted a randomized, controll double-blind thought to compare the efficacy of sodium valproate and prochlorperazine in the emergent treatment of patients with migraine.

Patients with uncomplicated migraine headaches were randomized to receive 10 mg of prochlorperazine or 500 mg of sodium valproate intravenously. Patients graded their flats of pain, nausea, and sedation forward a vi-sual analog scale before treatment and at 15-minute intervals until 60 minutes after treatment.

the two groups demonstrated a significant difference in pain improvement, with patients receiving prochlorperazine showing a significantly greater decrease in pain and nausea scores. There was no difference in sedation scores. At the finis of the study, 15 of 19 patients receiving sodium valproate required further treatment, compared with five of the 20 patients in the prochlorperazine form into groups Two patients in the prochlorperazine assemblage received 25 mg of intravenous diphenhydramine for possible extrapyramidal reactions.

The authors judge that, compared with prochlorperazine, sodium valproate does not significantly model the pain and nausea associated with acute migraine headache. The short follow-up period may have masked purports of sodium valproate that could present itself after 60 minutes.

Tanen DA, et al. Intravenous sodium valproate versus prochlorperazine for the difficulty department treatment of acute migraine headaches: a prospective, randomized, double-blind trial. Ann Emerg M June 2003;41:847-53

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group