Continuous Intravenous Valproic Acid as an Abortive Therapy for Pediatric Migraine (P1.341)

OBJECTIVES:
To study the efficacy of continuous intravenous valproic acid as an abortive therapy for pediatric migraine .
 BACKGROUND:
Valproic acid (VPA) has been reported to be effective in status epilepticus and prophylaxis of migraine headache. IV VPA as bolus dose has also shown to be effective as an outpatient abortive therapy in children but its pharmacokinetic profile suggests that it would be more effect given as a continuous infusion. DESIGN/METHODS:
This is a retrospective chart review of all children admitted to Kentucky Children Hospital from August 2009 to August 2012 and treated with IV VPA. Children in migraine status were treated by standard protocol: IV VPA load 20mg/kg followed by continuous infusion of 1 mg/kg/hour. Serum VPA levels were checked at 4, 24 and 48 hours. The target serum concentration was 100(+/-10),Standard pain scoring (FACES for ages 4-8 and VAS for >8 year) was used. Response was graded according to reduction in pain scoring as Excellent (> than 50 %) Moderate (> than 30 % but < than 50 %) and Poor (< than 30 %). RESULTS:
78 subjects met criteria. They were 24 boys (32%), 54 girls (69 %), ages 4 to 18 year (mean 12.9 +/-3.34 %). . 59 (75%)reported an excellent response, 9 (11.5 %) a moderate response and 10 (12.8%) a poor response. 68%with excellent response responded within first 12 hours.
Age and gender did not affect the likelihood of response. The only reported side effect, Nausea, was noticed in 5 children. 
CONCLUSIONS:
Continuous infusion IV VPA is a safe, rapidly effective, abortive agent in pediatrics Migraine. Randomized, double blind, controlled studies are warranted Disclosure: Dr. Zafar has nothing to disclose. Dr. Cook has nothing to disclose. Dr. Stewart has nothing to disclose. Dr. Baumann has nothing to disclose.