Management of Pediatric Migraine Headache in the Emergency Room and Infusion Center

Kabbouche, Marielle A.

doi:10.1111/head.12694

Cited by 16 publications

(10 citation statements)

References 27 publications

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“…Although there is a growing body of evidence to support recommendations for the acute treatment of pediatric migraine, challenges remain. Many children and adolescents do not respond to treatment at home with NSAIDs and triptans and seek pain relief at an ED or infusion center . Trials of refractory headache treatment in children and adolescents have been conducted but therapeutic approaches in these circumstances vary .…”

Section: Suggestions For Future Researchmentioning

confidence: 99%

Practice guideline update summary: Acute treatment of migraine in children and adolescents

et al. 2019

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Objective To provide evidence‐based recommendations for the acute symptomatic treatment of children and adolescents with migraine. Methods We performed a systematic review of the literature and rated risk of bias of included studies according to the American Academy of Neurology classification of evidence criteria. A multidisciplinary panel developed practice recommendations, integrating findings from the systematic review and following an Institute of Medicine‐compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence. Results There is evidence to support the efficacy of the use of ibuprofen, acetaminophen (in children and adolescents), and triptans (mainly in adolescents) for the relief of migraine pain, although confidence in the evidence varies between agents. There is high confidence that adolescents receiving oral sumatriptan/naproxen and zolmitriptan nasal spray are more likely to be headache free at 2 hours than those receiving placebo. No acute treatments were effective for migraine‐related nausea or vomiting; some triptans were effective for migraine‐related phonophobia and photophobia. Recommendations Recommendations for the treatment of acute migraine in children and adolescents focus on the importance of early treatment, choosing the route of administration best suited to the characteristics of the individual migraine attack, and providing counselling on lifestyle factors that can exacerbate migraine, including trigger avoidance and medication overuse.

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Section: Suggestions For Future Researchmentioning

confidence: 99%

Practice guideline update summary: Acute treatment of migraine in children and adolescents

et al. 2019

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“…For those who did, the evidence-based options are limited to intravenous prochlorperazine. If prochlorperazine is not available, metoclopramide could be used instead [69]. However, results of a RCT performed in adults suggest that, although metoclopramide is more effective than placebo, it is also much less effective than prochlorperazine [70].…”

Section: Migrainementioning

confidence: 99%

Managing Pediatric Pain in the Emergency Department

Bailey

Trottier

2016

Pediatr Drugs

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Far more attention is now given to pain management in children in the emergency department (ED). When a child arrives, pain must be recognized and evaluated using a pain scale that is appropriate to the child's development and regularly assessed to determine whether the pain intervention was effective. At triage, both analgesics and non-pharmacological strategies, such as distraction, immobilization, and dressing should be started. For mild pain, oral ibuprofen can be administered if the child has not received it at home, whereas ibuprofen and paracetamol are suitable for moderate pain. For patients who still require pain relief, oral opioids could be considered; however, many EDs have now replaced this with intranasal fentanyl, which allows faster onset of pain relief and can be administered on arrival pending either intravenous access or definitive care. Intravenous opioids are often required for severe pain, and paracetamol or ibuprofen can still be considered for their likely opioid-sparing effects. Specific treatment should be used for patients with migraine. In children requiring intravenous access or venipuncture, non-pharmacological and pharmacological strategies to decrease pain and anxiety associated with needle punctures are mandatory. These strategies can also be used for laceration repairs and other painful procedures. Despite the gaps in knowledge, pain should be treated with the most up-to-date evidence in children seen in EDs.

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“…If several triptans are ineffective, especially in patients who have constant, unremitting pain, intranasal dihydroergotamine may be helpful for headache exacerbations, and can also be combined with NSAIDs and/or antiemetics. When home remedies are not sufficient, intravenous medications are highly effective for children and adolescents with status migrainosus . There is also some data supporting the use of occipital nerve blocks for treatment of acute, severe headaches, and a pediatric trial is ongoing (https://clinicaltrials.gov/ct2/show/NCT03526874).…”

Section: Introductionmentioning

confidence: 99%