Efficacy of IV Valproic Acid and Oral Valproic Acid Tapers for the Treatment of Pediatric Headaches in the Emergency Department.
| Title: | Efficacy of IV Valproic Acid and Oral Valproic Acid Tapers for the Treatment of Pediatric Headaches in the Emergency Department. |
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| Authors: | Rosenthal S; Department of Pediatrics Section of Neurology (SR, EM, HWG, SG, J. Marks, JJ, R. Messer, J. Martin, MEY), Department of Pediatrics (MS, LS), and Department of Pediatrics Section of Emergency Medicine (R. Mistry), University of Colorado Anschutz School of Medicine; and Department of Pediatrics and Neurology (CAP), University of Pennsylvania Perelman School of Medicine.; Mazzio E; Department of Pediatrics Section of Neurology (SR, EM, HWG, SG, J. Marks, JJ, R. Messer, J. Martin, MEY), Department of Pediatrics (MS, LS), and Department of Pediatrics Section of Emergency Medicine (R. Mistry), University of Colorado Anschutz School of Medicine; and Department of Pediatrics and Neurology (CAP), University of Pennsylvania Perelman School of Medicine.; Wellman Gilbert H; Department of Pediatrics Section of Neurology (SR, EM, HWG, SG, J. Marks, JJ, R. Messer, J. Martin, MEY), Department of Pediatrics (MS, LS), and Department of Pediatrics Section of Emergency Medicine (R. Mistry), University of Colorado Anschutz School of Medicine; and Department of Pediatrics and Neurology (CAP), University of Pennsylvania Perelman School of Medicine.; Guistolisi S; Department of Pediatrics Section of Neurology (SR, EM, HWG, SG, J. Marks, JJ, R. Messer, J. Martin, MEY), Department of Pediatrics (MS, LS), and Department of Pediatrics Section of Emergency Medicine (R. Mistry), University of Colorado Anschutz School of Medicine; and Department of Pediatrics and Neurology (CAP), University of Pennsylvania Perelman School of Medicine.; Marks J; Department of Pediatrics Section of Neurology (SR, EM, HWG, SG, J. Marks, JJ, R. Messer, J. Martin, MEY), Department of Pediatrics (MS, LS), and Department of Pediatrics Section of Emergency Medicine (R. Mistry), University of Colorado Anschutz School of Medicine; and Department of Pediatrics and Neurology (CAP), University of Pennsylvania Perelman School of Medicine.; Jewell J; Department of Pediatrics Section of Neurology (SR, EM, HWG, SG, J. Marks, JJ, R. Messer, J. Martin, MEY), Department of Pediatrics (MS, LS), and Department of Pediatrics Section of Emergency Medicine (R. Mistry), University of Colorado Anschutz School of Medicine; and Department of Pediatrics and Neurology (CAP), University of Pennsylvania Perelman School of Medicine.; Straley M; Department of Pediatrics Section of Neurology (SR, EM, HWG, SG, J. Marks, JJ, R. Messer, J. Martin, MEY), Department of Pediatrics (MS, LS), and Department of Pediatrics Section of Emergency Medicine (R. Mistry), University of Colorado Anschutz School of Medicine; and Department of Pediatrics and Neurology (CAP), University of Pennsylvania Perelman School of Medicine.; Silveira L; Department of Pediatrics Section of Neurology (SR, EM, HWG, SG, J. Marks, JJ, R. Messer, J. Martin, MEY), Department of Pediatrics (MS, LS), and Department of Pediatrics Section of Emergency Medicine (R. Mistry), University of Colorado Anschutz School of Medicine; and Department of Pediatrics and Neurology (CAP), University of Pennsylvania Perelman School of Medicine.; Messer R; Department of Pediatrics Section of Neurology (SR, EM, HWG, SG, J. Marks, JJ, R. Messer, J. Martin, MEY), Department of Pediatrics (MS, LS), and Department of Pediatrics Section of Emergency Medicine (R. Mistry), University of Colorado Anschutz School of Medicine; and Department of Pediatrics and Neurology (CAP), University of Pennsylvania Perelman School of Medicine.; Martin J; Department of Pediatrics Section of Neurology (SR, EM, HWG, SG, J. Marks, JJ, R. Messer, J. Martin, MEY), Department of Pediatrics (MS, LS), and Department of Pediatrics Section of Emergency Medicine (R. Mistry), University of Colorado Anschutz School of Medicine; and Department of Pediatrics and Neurology (CAP), University of Pennsylvania Perelman School of Medicine.; Mistry R; Department of Pediatrics Section of Neurology (SR, EM, HWG, SG, J. Marks, JJ, R. Messer, J. Martin, MEY), Department of Pediatrics (MS, LS), and Department of Pediatrics Section of Emergency Medicine (R. Mistry), University of Colorado Anschutz School of Medicine; and Department of Pediatrics and Neurology (CAP), University of Pennsylvania Perelman School of Medicine.; Yonker ME; Department of Pediatrics Section of Neurology (SR, EM, HWG, SG, J. Marks, JJ, R. Messer, J. Martin, MEY), Department of Pediatrics (MS, LS), and Department of Pediatrics Section of Emergency Medicine (R. Mistry), University of Colorado Anschutz School of Medicine; and Department of Pediatrics and Neurology (CAP), University of Pennsylvania Perelman School of Medicine.; Press CA; Department of Pediatrics Section of Neurology (SR, EM, HWG, SG, J. Marks, JJ, R. Messer, J. Martin, MEY), Department of Pediatrics (MS, LS), and Department of Pediatrics Section of Emergency Medicine (R. Mistry), University of Colorado Anschutz School of Medicine; and Department of Pediatrics and Neurology (CAP), University of Pennsylvania Perelman School of Medicine. |
| Source: | Neurology. Clinical practice [Neurol Clin Pract] 2023 Aug; Vol. 13 (4), pp. e200170. Date of Electronic Publication: 2023 Jun 06. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 101577149 Publication Model: Print-Electronic Cited Medium: Print ISSN: 2163-0402 (Print) Linking ISSN: 21630402 NLM ISO Abbreviation: Neurol Clin Pract Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: Hagerstown, MD : Lippincott Williams & Wilkins |
| Abstract: | Background and Objectives: Pediatric headaches, including migraine, are a common reason for emergency department (ED) presentation. IV valproic acid (VPA) followed by oral VPA tapers are often used to abort pediatric headache and reduce recurrence, though limited data exist regarding this approach. This study evaluated the effectiveness of IV VPA and oral VPA tapers for the treatment of acute pediatric headaches in the ED in preventing return encounters.; Methods: This is a retrospective cohort study of patients aged 5-21 years presenting to a tertiary-care pediatric ED from 2010 to 2016 who received IV VPA for headache or migraine. Primary outcomes were ED disposition, percent pain reduction (initial vs 2-hour patient-reported pain score [10-point scale]), and return for acute headache treatment within 1 month.; Results: A total of 486 ED encounters were included with a median patient age of 15 years; most of them were females (76%, 369/486). Of available pain scores within 2 hours of IV VPA administration, 41% (173/425) had ≥50% pain reduction. Fifty-two percent (254/486) were discharged without additional treatment, 14% (69/486) were discharged after additional treatment, and 33% (163/486) were admitted to the hospital. Initial pain score, number of preceding home treatments, and number of preceding ED treatments were not associated with ED disposition. Oral VPA tapers were prescribed in 39% (94/253) of encounters when the patient was discharged after IV VPA. Oral VPA tapers produced a transient decrease in recurrence at 72 hours, which was no longer present at 1 week nor 1 month. There was no difference in the time to recurrence or total number of return visits within 1 month.; Discussion: IV VPA was efficacious in treating pediatric headaches evaluated in the ED, with nearly two-thirds of patients discharged home after administration. Oral VPA tapers did not reduce total headache recurrence nor time to recurrence. Given the limited benefit of oral VPA tapers, this practice should be re-examined.; Classification of Evidence: This study provides Class IV evidence that for children with headache seen in the ED, IV VPA reduces head pain and Class III evidence that following this with an oral VPA taper is of no benefit.; (© 2023 American Academy of Neurology.) |
| Competing Interests: | The authors report no relevant disclosures. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp. |
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| Entry Date(s): | Date Created: 20230609 Latest Revision: 20240802 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC10245683 |
| DOI: | 10.1212/CPJ.0000000000200170 |
| PMID: | 37292258 |
| Database: | MEDLINE |
Journal Article