Abstract Details

Title Efficacy of Intravenous Valproic Acid and Oral Valproic Acid Tapers for Treatment of Pediatric Headaches in the Emergency Department

Topic Headache

Presentation(s) P15 - Poster Session 15 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-001

Background Headache, including migraine, is a common reason for ED presentation. IV VPA followed by oral VPA tapers are commonly used in children, though limited data supports this approach.

Objective To characterize the efficacy of intravenous (IV) valproic acid (VPA) for treatment of acute pediatric headaches evaluated in the emergency department (ED) and oral VPA tapers in preventing return treatment encounters.

Design/Methods

Retrospective cohort study of patients 5-21 years old presenting to a tertiary-care pediatric ED from 2010-2016 receiving IV VPA for headache. 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 one month.

Results 486 ED encounters were included with an average patient age of 15 years; 76% of patients were female (369/486). Of available pain scores within two hours of IV VPA administration, forty-one percent (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 disposition from the ED. Median time to IV VPA administration was significantly longer for those admitted compared to discharged (302 vs. 248 min, p<0.001). Thirty-nine percent (94/253) of patients who discharged from the ED without further intervention were prescribed an oral VPA taper. There was no association between prescription of oral VPA tapers and the frequency of return visits within 1 month nor time to return for repeat treatment.

Conclusions IV VPA was efficacious in treating pediatric headache evaluated in the ED, with nearly two-thirds of patients discharging after administration. Oral VPA tapers did not improve patient outcomes, raising questions about the benefit of this practice.

Authors/Disclosures
Scott Rosenthal, MD (University of Colorado) PRESENTER	Dr. Rosenthal has a non-compensated relationship as a Sub-Investigator with Biohaven and Teva that is relevant to AAN interests or activities.
Emma L. Mazzio, MD (Childrens Hospital of Philadelphia)	Dr. Mazzio has nothing to disclose.
Hannah Wellman, MD (Children's Hospital Colorado)	Dr. Wellman has nothing to disclose.
	No disclosure on file
Jerry Jewell, MD (University of Colorado)	Jerry Jewell has nothing to disclose.
Sarah Guistolisi, MD	Dr. Guistolisi has nothing to disclose.
Jan A. Martin, MD (University of Washington/Seattle Children's Hospital)	Dr. Martin has nothing to disclose.
Ricka Messer, MD (Children'S Hospital Colorado)	Dr. Messer has nothing to disclose.
	No disclosure on file
Marcy E. Yonker, MD (Children's Hospital of Colorado)	The institution of Dr. Yonker has received research support from NINDS. The institution of Dr. Yonker has received research support from PCORI. The institution of Dr. Yonker has received research support from TEVA. The institution of Dr. Yonker has received research support from AMGEN. The institution of Dr. Yonker has received research support from Pfizer. The institution of Dr. Yonker has received research support from Lilly. The institution of Dr. Yonker has received research support from Abbvie.
Craig A. Press, MD, PhD (Children's Hospital of Philadelphia)	Dr. Press has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Marinus Pharmaceuticals. Dr. Press has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Law Firms. Dr. Press has received research support from Marinus Pharmaceuticals. Dr. Press has received research support from Pediatric Epilepsy Research Foundation. Dr. Press has received research support from NIH.