New ER treatment for CH ??

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Posted by Bob Johnson ( on August 16, 2001 at 09:37:09:

If you are blessed to be working with a doctor who has good experience treating headache you may wish to print out this message and share this article. It is clearly a new technique--I could find no other references to it--although the use of valproate in pill form is generally well established as a treatment for CH.

If your doc is willing to try this approach, he/she could easily consult with Dr. Krusz for more details..


WESTPORT, CT (Reuters Health) Aug 14 - Intravenous administration of valproate sodium "rapidly and forcefully" treats ongoing intractable migraine headache without causing side effects, according to Dr. John Claude Krusz of Anodyne PainCare in Dallas.

Dr. Krusz treated 85 patients who had experienced no relief after treatment with standard therapies. As he reports in Headache Quarterly, many of the patients were in their second or third day of intractable headache.

The protocol involved administration of a bolus injection of valproate sodium 100 mg every 5 minutes until maximal relief was obtained. This required a mean of 750 mg, with maximal response averaging 50 minutes.

On a scale of 0 to 11, the average patient rating was 88% relief of symptoms, with 59 patients reporting complete relief. No problems with drowsiness or euphoria were reported, although most patients experienced a sense of feeling very calm after treatment.

"The beauty of it is there's no altered consciousness. Patients can go right back to work," Dr. Krusz told Reuters Health. He noted that other investigators have published similar data, but "we're a little more aggressive in our dosing, and our percentage results are a little better."

"I've had emergency room docs say they're not comfortable with using [IV valproate]," he commented. "But I've taught doctors at my hospital to use it. I think in another year or two we'll have a much better comfort level with its use."

Dr. Krusz pointed out an emerging pattern of behavior on the part of insurance companies that is leading to increased use of emergency department or other on-site treatment of migraine headaches.

"They tend to play games," he said. For example, he noted, a company may only allow a less effective drug on their formulary, "even if the price of the more effective drug is within 20 cents of the one that doesn't work."

"Then they'll cut back and say patients are only allowed so many doses per month," Dr. Krusz continued. "The bean counters don't care how many thousands of dollars it costs for patients to go to the ER, because that doesn't affect what they're accountable for."

Headache Q 2001;12:39-41.

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