Emergency Department Management of Acute Migraine in Children in Canada: A Practice Variation Study

Richer, Lawrence; Graham, Lee; Klassen, Terry P.; Rowe, Brian H.

doi:10.1111/j.1526-4610.2007.00782.x

Cited by 48 publications

(37 citation statements)

References 18 publications

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“…5,18 The current study population is similar to previous reports in which up to one-third of patients do not require specific migraine treatment but are presenting to the ED for a diagnostic evaluation of the headache. 9 In agreement with previous publications of pediatric migraine in ED's, 5 one-half of the children receive intravenous fluids as part of the treatment or to prevent some of the mild hypotension associated with administration of dopamine receptor antagonists.…”

Section: Discussionsupporting

confidence: 64%

“…Previous studies have focused on variation in care, 9,15 comparing treatments in pediatric EDs to general EDs, 9 safety of specific medications, 6,16,17 and the value of treatment protocols using available evidence. 5,18 The current study population is similar to previous reports in which up to one-third of patients do not require specific migraine treatment but are presenting to the ED for a diagnostic evaluation of the headache.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Treatment in a pediatric ED rather than a general ED has been associated with increased use of dopamine antagonists, less use of opioids, and increased rates of headache resolution. 9 ED studies in adults have investigated the efficacy of dopamine receptor antagonists, analgesics including nonsteroidal medications and opiates, and triptans.…”

mentioning

confidence: 99%

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

2015

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BACKGROUND AND OBJECTIVES: Migraine headache is a common pediatric complaint among emergency department (ED) patients. There are limited trials on abortive therapies in the ED. The objective of this study was to apply a comparative effectiveness approach to investigate acute medication regimens for the prevention of ED revisits. METHODS:Retrospective study using administrative data (Pediatric Health Information System) from 35 pediatric EDs (2009EDs ( -2012. Children aged 7 to 18 years with a principal diagnosis of migraine headache were studied. The primary outcome was a revisit to the ED within 3 days for discharged patients. The primary analysis compared the treatment regimens and individual medications on the risk for revisit. RESULTS:The study identified 32 124 children with migraine; 27 317 (85%) were discharged, and 5.5% had a return ED visit within 3 days. At the index visit, the most common medications included nonopioid analgesics (66%), dopamine antagonists (50%), diphenhydramine (33%), and ondansetron (21%). Triptans and opiate medications were administered infrequently (3% each). Children receiving metoclopramide had a 31% increased odds for an ED revisit within 3 days compared with prochlorperazine. Diphenhydramine with dopamine antagonists was associated with 27% increased odds of an ED revisit compared with dopamine antagonists alone. Children receiving ondansetron had similar revisit rates to those receiving dopamine antagonists. CONCLUSIONS:The majority of children with migraines are successfully discharged from the ED and only 1 in 18 required a revisit within 3 days. Prochlorperazine appears to be superior to metoclopramide in preventing a revisit, and diphenhydramine use is associated with increased rates of return.WHAT'S KNOWN ON THE SUBJECT: Migraine headaches are a common presenting complaint in emergency departments. Abortive treatment in this setting is not well studied, leading to considerable variation in treatment. The relationship between acute medications and emergency department revisits has not been studied. WHAT THIS STUDY ADDS:Eighty-five percent of children with migraine are successfully discharged from the emergency department; only 1 in 18 children require a return visit. Prochlorperazine is associated with less revisits than metoclopramide, and diphenhydramine use is associated with increased risk of return visits.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

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

2015

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“…Among agents that have shown efficacy and safety in controlled trials are nonsteroidal anti-inflammatory drugs, acetaminophen, triptans, and dopamine antagonists. 7,14 VPA is commonly prescribed for epilepsy. It is also used for mood disorders, chronic migraine, and neuropathic pain.…”

Section: Discussionmentioning

confidence: 99%

Acute Confusional Migraine in an Adolescent: Response to Intravenous Valproate

Avraham¹,

Har-Gil²,

Watemberg³

2010

Pediatrics

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Acute confusional migraine (ACM) is a dramatic, rare manifestation of migraine described mostly for children and adolescents. There are few data on the treatment of an ACM attack. Prochlorperazine has been suggested as an effective drug. The authors of some reports have suggested that valproic acid may play a role in the prevention of ACM and as treatment for acute migraine headache in the adult population. However, this medication has not been reported as first-line, acute therapy for ACM. We report here the case of a 12-year-old girl who presented with an ACM attack that resolved rapidly after intravenous administration of valproic acid.

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“…The most common drugs prescribed for first-line therapy in acute migraine attacks are simple oral analgesics and metoclopramide in children and adults admitted to the emergency department (1)(2)(3). Metoclopramide, an antiemetic drug, is a D 2 receptor antagonist, an HT 4 receptor agonist, and a weak 5HT 3 antagonist.…”

Section: Introductionmentioning

confidence: 99%

Metoclopramide inhibits trigeminovascular activation:evidence for effective acute attack treatment in migraine

et al. 2017

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Background/aim: Metoclopramide is an effective and commonly used medication in acute migraine treatment but an experimental evidence base is lacking. We aimed to investigate the antimigraine effect of metoclopramide in a migraine model and whether the analgesic effect of metoclopramide was likely to be D 2 receptor-mediated.Materials and methods: Cortical spreading depression (CSD) was used to model migraine in adult male Wistar rats. Five CSDs were induced by pinprick. Metoclopramide (two different doses), raclopride, or 0.9% saline were administered 30 min before CSD induction. Two hours after the experiments, brain tissues were examined for c-fos activation. Results:In metoclopramide groups brain stem c-fos expression was significantly lower than in the CSD side of the saline group (P = 0.002). In the raclopride group, ipsilateral brain stem c-fos expression was also lower than in the saline group (P = 0.002). No difference in c-fos expression in the ipsilateral trigeminal nucleus caudalis between the raclopride and metoclopramide groups was observed (P > 0.05). Conclusion:Metoclopramide is shown to suppress trigeminovascular activation for the first time, providing an experimental basis for its role in migraine. The analgesic effect of metoclopramide is likely to be mediated by D 2 receptors since raclopride, a selective D 2 receptor antagonist, suppresses trigeminovascular activation similarly.

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Emergency Department Management of Acute Migraine in Children in Canada: A Practice Variation Study

Cited by 48 publications

References 18 publications

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

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

Acute Confusional Migraine in an Adolescent: Response to Intravenous Valproate

Metoclopramide inhibits trigeminovascular activation:evidence for effective acute attack treatment in migraine

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