Clinical outcomes of children treated with intravenous prochlorperazine for migraine in a pediatric emergency department.
Author(s): Trottier ED, Bailey B, Dauphin-Pierre S, Gravel J
Affiliation(s): Division of Emergency Medicine, Universite de Montreal, Montreal, Quebec, Canada.
Publication date & source: 2010-08, J Emerg Med., 39(2):166-73. Epub 2009 Jan 15.
BACKGROUND: Prochlorperazine is the only treatment that has been studied so far in a randomized controlled trial and found to reduce pain at 1 h in children with migraine who presented to an emergency department (ED). OBJECTIVE: To evaluate the rate of treatment failure associated with prochlorperazine used in children with severe migraine in a pediatric ED. METHODS: This study was a retrospective chart review of patients < 18 years of age who visited the ED of a tertiary care pediatric hospital between November 2005 and June 2007. All patients diagnosed with migraine by the emergency physicians were included in the study. Charts were evaluated by a data abstractor blinded to the study hypothesis using a standardized datasheet. Inter-rater agreement was measured. Prochlorperazine treatment failure was defined as either administration of further rescue therapy, a hospitalization, or a return visit to the ED within 48 h for symptom recurrence or side effects from the medication. RESULTS: Prochlorperazine was administered in 92 episodes of migraine, including 43 confirmed by a pediatric neurologist; all received diphenhydramine to prevent akathisia. A total of 13 (14%) of these patients had a treatment failure: 8 patients received one or more further rescue therapies after the administration of prochlorperazine; 5 patients were hospitalized, including 3 who had received further rescue therapy; and 3 patients returned to the ED within 48 h due to symptom recurrence. CONCLUSION: There was a treatment failure rate of 14% with the use of prochlorperazine in association with diphenhydramine for severe migraine in children seen in a pediatric ED. Copyright 2010 Elsevier Inc. All rights reserved.