Relative Effectiveness of Dopamine Antagonists for Pediatric Migraine in the Emergency Department. Issue 3 (March 2018)

• Record Type: Journal Article
• Authors: Sheridan, David C.; Laurie, Amber; Pacheco, Stephanie; Fu, Rongwei; Hansen, Matthew L.; Ma, O. John; Meckler, Garth D.
• Is Part Of: Pediatric emergency care. Volume 34:Issue 3(2018)
• Publication Date: 2018-03
• Subjects: neurology -- pain -- migraine -- headache; Pediatric emergencies -- Periodicals; 618.92002505
• DOI: 10.1097/PEC.0000000000000718
• Languages: English
• ISSNs: 0749-5161

Abstract

Abstract : Objective: Migraine headaches are common in the pediatric emergency department. The mainstay of abortive treatment consists of nonsteroidal anti-inflammatories and dopamine antagonists. The objective of this study was to compare the effectiveness of 3 commonly used dopamine antagonists to abort pediatric migraine. Methods: This was a retrospective cohort study of all patients who presented to the pediatric emergency department at a tertiary care pediatric hospital between January 2010 and December 2013. Patients were treated for a migraine headache with a combination of ketorolac and one of the following dopamine antagonists: prochlorperazine, metoclopramide, or promethazine. The primary outcome was treatment failure and receiving non–evidence-based treatment defined by the need for opioids. Secondary outcomes included pain score reduction and return visit within 48 hours. Results: There were 57 patients during this period with 67 visits that met inclusion criteria: 27 (40.3%) visits in which patients were treated with prochlorperazine, 23 (34.3%) visits in which patients were treated with metoclopramide, and 17 (25.4%) visits in which patients were treated with promethazine. Across visits, the mean age was 14.5 years, and 63% were women. Opioids were given for treatment failure in 8.7% of visits in which patients received prochlorperazine, 25% in which patients received metoclopramide, and 42.8% in which patients received promethazine. Patients treated with promethazine had significantly higher odds of needing opioids and experiencing less than 50% reduction in pain score compared with prochlorperazine after adjusting for patient characteristics. Conclusions: This study suggests variable efficacy among 3 commonly used dopamine antagonists for pediatric migraine headache. Promethazine seems least effective and results in higher use of opioids compared with other available dopamine antagonists.