Is Valproic Acid Helpful for Acute Confusional Migraine?

Valproic acid, and the related compound divalproex acid (Depakote) are very common migraine preventatives.  But their use as abortives – to kill a specific migraine attack – has never been established.

However, some researches still see possibilities, especially in the emergency room.

One case in Israel concerned an adolescent with Acute Confusional Migraine (ACM).  This is a rare migraine manifestation in children, generally those ages 5-16.  During an attack, the patient becomes confused, and usually agitated.  There may be headache before or after this phase of the attack.  The full attack usually lasts from 30 minutes to 24 hours.  The suggestion has been made that this is a clear link between migraine and epilepsy.

In this particular case, a 12 year old girl with ACM was given valproic acid intravenously 3 hours and 45 minutes into the attack.  Within 30 minutes, the girl had recovered fully, and had no symptoms for at least several months.

Another case study, involving a 10 year old girl, involved valproic acid as a preventative (2007).

Further research certainly needs to be done into the use of valproic acid in the emergency room, and especially its use in ACM patients, since there has been very little research done for the treatment of this rare type of migraine.

For the full case report, read Acute Confusional Migraine in an Adolescent: Response to Intravenous Valproate