Clinical Outcomes of Children Treated with Intravenous Prochlorperazine for Migraine in a Pediatric Emergency Department

A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department

“…21 In the current study, diphenhydramine was used in nearly one-third of children and was found to increase the risk of revisit. We cannot determine whether the diphenhydramine was administered as part of the treatment regimen or in response to adverse effects of other medications; the reported rates of definite akathisia with dopamine antagonists is only 5%, 22 suggesting that the diphenhydramine was more likely administered prophylactically. For those that experienced extrapyramidal symptoms, these symptoms can be prolonged beyond the ED visit and therefore may account for some revisits being attributed to diphenhydramine use.…”

The Use of a Pediatric Migraine Practice Guideline in an Emergency Department Setting

“…41 Failure rates of treatment, commonly defined as the need for a second rescue drug, headache recurrence within 48 hours, and readmission, range from 10% to 50% with the use of DRAs. 9,11,13,21,[41][42][43][44][45] The admission rates of pediatric patients with migraine headaches are reported in the literature from 3% to 32%. 8,13 We had an admission rate of 7.5%, although we did not evaluate the relapse rate or readmission rate for our patients discharged from the ED.…”

“…[5][6][7] In addition, it has been suggested that migraines play a role in childhood depression. [8][9][10][11] Despite sometimes effective outpatient treatment, many children present to the emergency department (ED) after 2 to 3 days of headaches when home-based migraine abortive therapies have failed. 12 Migraine headaches do not always respond to treatment in the ED, and intractable cases can require inpatient hospital admission for pain and other associated symptoms.…”

Factors Associated With Discharge After Initial Emergency Treatment of Pediatric Migraine

“…The efficacy of prochlorperazine as an abortive agent for migraine has been demonstrated in multiple studies, [12][13][14]16 and the standardized combination of IV ketorolac with IV prochlorperazine has been associated with improved pain reduction, decreased ED visit duration, and decreased rates of admission compared with nonstandardized treatment in the pediatric ED. 16 Our results are in accordance with these data and suggest that the addition of IV prochlorperazine to IV ketorolac may help improve discharge rates from the ED.…”

“…[1][2][3] There is wide practice variation in emergent migraine management 1-3 and limited evidence for optimal migraine management in the pediatric ED. In pediatric patients, ibuprofen, 4-6 acetaminophen, 4,6 sumatriptan, [7][8][9][10][11] and prochlorperazine [12][13][14] have been shown to be effective migraine abortive therapies, but only prochlorperazine has been validated with a randomized controlled trial in a pediatric ED setting. 12 Furthermore, there have been no direct comparisons of efficacy of intravenous (IV) versus oral or intranasal (PO/IN) abortive medications for migraine treatment.…”