(848) Comparative Efficacy of Lidocaine Infusion vs Valproate Infusion for Status Migrainosus in Children

Introduction: The objective of this study is to compare the safety and efficacy of sodium valproate infusion and lidocaine infusion in the treatment of pediatric status migrainosus

Methods: Single center retrospective cohort study

Results: During the study period 94 patients were treated with lidocaine (n=31) or sodium valproate infusion (n=63) for the management of status migrainosus in the pediatric ICU. There were no significant differences in the demographic profile of patients in the two groups with a median age of 15 years (75% female), except for a higher proportion of patients with comorbidities in the valproate group. Patients in the lidocaine group achieved significantly faster control of pain with median hours to pain free of 11.7 (IQR, 3.8, 32.3) hours compared to 43.4 (IQR 13.8, 68.7) hours in the valproate group (p=0.002). At discharge 21/31 (67.7%) of patients receiving lidocaine were pain free compared to 26/59 (44.07%) of patients receiving valproate (p=0.03). There were significantly more infusion interruptions of valproate compared to lidocaine for various patient related factors (16/63, 25.4% vs. 1/31, 3.2%), p= 0.009. Valproate infusion had much higher incidence of any side effect at 67% (42/63) compared to only 3.2% (1/31) in the lidocaine group (p < 0.001). The superiority of lidocaine infusion persisted after controlling for sex, race, age, body mass index, presence of comorbidities and pain score at admission on multivariable linear regression of hours to pain control. All patients in both groups completed the infusions and were discharged home.

Conclusions: Intravenous lidocaine infusion offers superior pain control and has a better safety profile compared to intravenous sodium valproate infusion for headache control from status migrainosus.