Breaking News on Migraine
In a study reported by Minnesota Epilepsy Group researchers in Epilepsia (1999;40[suppl 7]:143), intravenous valproate was found to be useful as an abortive treatment for migraine headache.
In an open-label, randomized study, patients with a history of migraines (and suffering from moderate to severe migraines lasting 24 to 72 hours) were given either I.V valproate (Depacon Injection, Abbott) or intramuscular dihydroergotamine (D.H.E. 45, Novartis) with metoclopramide (Reglan Injectable, Robins; various). A total of 15 patients received valproate 500 mg for long enough to allow them to be evaluated (>=30 minutes).There were also 15 patients in the dihydroergotamine group.
After one hour, 60% of patients in the valproate group reported relief from their headaches, compared to 40% in the dihydroergotamine group. At two hours, these figures were 67% and 47% for the valproate and dihydroergotamine patients, respectively. After four hours, 67% of valproate patients and 53% of dihydroergotamine patients experienced migraine relief. A significant number of individuals in both groups reported a decrease in nausea, photophobia and phonophobia.
Because of the similar, and in some cases superior, results compared to dihydroergotamine therapy, the researchers cited I.V valproate as a possible treatment for patients "in an acute treatment setting after use of a triptan or ergotamine."
Ususally, the prescription migraine drug Maxalt (rizatriptan) is taken at the first sign of a migraine attack. But a recent study showed that the drug is also effective when administered any time after headache onset, according to data presented recently at the 52nd Annual Meeting of the American Academy of Neurology.
Dr. Marc Berger, a neurologist with the University of Southern California in Los Angeles, and colleagues elsewhere, found that the medication relieved migraine symptoms when administered at the onset of headache or when headache progressed to moderate or severe. What's more, no outcome differences were observed two hours after treatment.
The study included 1,919 migraine patients who were treated with either a rizatriptan tablet or an orally disintegrating tablet for two migraine attacks. Patients chose which formulation to take first. Overall, 3,450 migraine episodes were evaluated.
Participants in the study were on average 41 years old, and 88% were women. Most of those studied reported about one migraine attack per week.
Twenty three percent of patients who took the medication at the start of their migraine episode had headache relief within 30 minutes of treatment compared with 18% of those who waited until their headache became moderate or severe.
Likewise, significantly more patients in the so-called early drug use group reported feeling better and returned to their usual activities one hour after treatment. No difference was observed with respect to headache severity two hours after treatment; 65% of patients in the early drug use group and 67% of those in the delayed drug use group reported no pain or only mild pain.
Results also showed that about 60% of migraine attacks were not treated until the headache progressed to moderate or severe.
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