Factors Associated With Discharge After Initial Emergency Treatment of Pediatric Migraine

Abstract

Arrival pain score may be used to help select initial migraine treatment in the pediatric ED. Initial use of PO/IN regimens including triptans or an antiemetic and concurrent administration of IV ketorolac with an antiemetic may be associated with higher rates of discharge after initial treatment alone.

Predictors of First‐Line Treatment Success in Children and Adolescents Visiting an Infusion Center for Acute Migraine

“…An alternate explanation for our finding may be due to the fact that the majority of the patients with MOH were not given intravenous ketorolac, and were treated with only an intravenous neuroleptic (metoclopramide or prochlorperazine) and an intravenous fluid bolus. Though high quality data suggest that neuroleptics are more efficacious for acute pediatric migraine than ketorolac, combination therapy may be superior to neuroleptics alone, at least based on preliminary data . It is not known what acute therapies are most effective for pediatric migraine with comorbid MOH and future work needs to explore how to treat this subpopulation.…”

“…To our knowledge, only one other study has assessed factors associated with first‐line treatment success for pediatric migraine in the acute setting. In a retrospective chart review of 700 ED visits for physician‐diagnosed pediatric migraine, discharge from the ED after first‐line intervention was more likely if patients received intravenous as compared to oral medication and for patients with lower baseline pain scores . Given the nature of these data, the investigators were not able to assess whether or not baseline migraine frequency, migraine type, or presence of medication‐overuse headache were associated with the probability of successful first‐line interventions, and the ICHD criteria were not used for case ascertainment.…”

“…Though high quality data suggest that neuroleptics are more efficacious for acute pediatric migraine than ketorolac, 16 combination therapy may be superior to neuroleptics alone, at least based on preliminary data. 11 It is not known what acute therapies are most effective for pediatric migraine with comorbid MOH and future work needs to explore how to treat this subpopulation.…”

“…In a retrospective chart review of 700 ED visits for physician-diagnosed pediatric migraine, discharge from the ED after first-line intervention was more likely if patients received intravenous as compared to oral medication and for patients with lower baseline pain scores. 11 Given the nature of these data, the investigators were not able to assess whether or not baseline migraine frequency, migraine type, or presence of medication-overuse headache were associated with the probability of successful firstline interventions, and the ICHD criteria were not used for case ascertainment. In our study, headache severity at presentation was also inversely related to first-line treatment success in a simple logistic regression model, but this association did not remain significant after controlling for age, sex, and diagnosis.…”

“…In addition, few prospective studies on pediatric migraine in the ED have been carried out and this patient population remains poorly characterized. Some studies have described trends in visits to the pediatric ED for headache [7][8][9] or have characterized the population of pediatric patients visiting acute settings with migraine [10][11][12][13] beyond basic demographics such as age and sex. Few of these studies have used the International Classification of Headache Disorders criteria (ICHD), 14 the accepted gold standard for migraine diagnosis, to ascertain migraine cases.…”