Thirty patients with persistent chronic daily headache, unresponsive to various combinations ofpharmacological and non-pharmacological treatment were selected for an open label study using divalproex sodium. All patients had normal liver function tests. After a baseline observation period of 1month, patients were given divalproex sodium 1000 to 2000 mg per day, for a period of 3 months. Blood valproic acid levels were kept between 75 and 100 mcg/ml. Liver function studies and blood ammonia levels were obtained periodically. Based on weekly headache index, headache-free days, dysfunctional days and patients' general well-being rating and physicians' global assessment, two thirds of the patients improved significantly. The common side effects included weight gain, tremor, hair loss and nausea. Liver functions were unaffected by treatment.
The possible mechanism of action of valproate in headache is discussed. Valproate appears to be aworthwhile addition to the prophylactic treatment of chronic recurrent headache.