Intravenous Valproate Aborts Glyceryl Trinitrate-Induced Migraine Attacks: a Clinical and Quantitative EEG Study

Abstract

We evaluated EEG changes and pain relief in migraineurs with glyceryl trinitrate (GTN)-induced attacks treated with intravenous sodium valproate (iSVP). EEG frequency analysis was performed in 45 migraineurs without aura and in 19 controls at baseline, at the time of maximum GTN-induced headache, and 30 min after 300 mg iSVP. Nineteen migraineurs presented early specific headache (migraine identical to spontaneous attacks; MSp) and 26 presented early non-specific headache (MnSp). During attacks in MSp there was an increase of theta [16.6% (14.8-19.3) to 19.4% (17.4-22.1), P = 0.02] and delta activity [3.6% (3.1-4.4) to 5.4% (3.9-6.5), P = 0.009], whereas there was no decrease in alpha [41.4% (36.2-45.1) to 39.7% (34.7-44.8)] or beta activity [37.6% (34.7-40.3) to 35.1% (33.5-38.8)]. iSVP reduced migraine from severe/moderate to mild/no pain in 17 (90%) MSp patients, and was associated with reversion of the slow rhythmic activity to baseline levels [theta 16.9% (14.6-18.9); delta 3.2% (3-4.1)]. There was no change in EEG frequency activity after administration of GTN or iSVP in controls and in MnSp. iSVP is well tolerated and effective in treating GTN-induced migraine in migraineurs without aura, and appears to restore the disturbances of cortical electrogenesis associated with these attacks.

Rapid absorption of sumatriptan powder and effects on glyceryl trinitrate model of headache following intranasal delivery using a novel bi-directional device

“…Consequently, this study does not allow direct determination of the GTN challenge‐induced qEEG changes. However, the latter has been characterized in previous studies with increase in relative slow‐wave activity described as the main effects in migraine sufferers during GTN‐induced headache whereas decrease in alpha and beta activity was not significant 30,31 . A similar pattern of EEG slowing appears to characterize migraine sufferers compared with controls 32–34 …”

Chemical Mediators of Migraine: Preclinical and Clinical Observations

“…Thus, NO has also been implicated in the mechanisms of other primary headaches. In addition, GTN‐induced attacks have been demonstrated to respond to typical acute headache treatments 158‐160 …”

“…In recent studies in migraineurs, GTN‐induced migraine has been aborted or averted successfully by several acute antimigraine drugs of differing mechanisms, including prednisolone, 159 sodium valproate, 160 and sumatriptan 178 . In contrast, the CGRP‐antagonist olcegepant failed to prevent GTN‐induced migraine, suggesting that CGRP may exert its migraine‐inducing effect upstream from NO in the migraine pathophysiology cascade 179 …”

Acute Confusional Migraine in an Adolescent: Response to Intravenous Valproate

“…3,4 Moreover, VPA has effectively reduced migrainous pain and reversed EEG migrainous pattern in glyceryl trinitrate-induced migraine attacks. 16 There have been few reports in the literature regarding the treatment of ACM. Indeed, only 2 case reports concerning pediatric patients have been published.…”