Treatment of Pediatric Migraine in the Emergency Room

Gelfand, Amy A.; Goadsby, Peter J.

doi:10.1016/j.pediatrneurol.2012.06.001

Cited by 29 publications

(18 citation statements)

References 95 publications

(155 reference statements)

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“…2,3 Although previous publications have discussed the management of pediatric migraine in the emergency department (ED), [4][5][6] there is only a single pediatric controlled trial conducted in the ED setting 7 ; therefore, most of the recommendations are based on treatment trials in adults or other non-ED settings with off-label use of medications.…”

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confidence: 99%

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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confidence: 99%

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

2015

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“…20 Despite the commonality and disturbances in a child's life due to migraines, few studies have been conducted to determine efficacy of treatments, especially in an ED setting. 4,8,21 Many published studies focus on treatments in the outpatient setting, for example, an outpatient clinic or at home 3,15,[22][23][24][25] despite the estimates that migraines represent 8% to 18% of all headaches seen in EDs. 15,26,27 In addition, many guidelines for the treatment of pediatric migraines are based on adult protocols.…”

Section: Discussionmentioning

confidence: 99%

“…15,26,27 In addition, many guidelines for the treatment of pediatric migraines are based on adult protocols. 4,15 The prevalence of migraines in children may be underestimated because of the fact that some children are likely treated outside the ED. These treatments commonly involve acetaminophen and ibuprofen.…”

Section: Discussionmentioning

confidence: 99%

“…4,48-51 In contrast, decreasing the infusion rate of prochlorperazine does not decrease the prevalence of akathisias. 4,52 Triptans have been studied in pediatric patients as an alternative to DRAs when treating migraines; however, no triptan is approved by the US Food and Drug Administration for treatment of adolescent migraines. 38 Studies have shown that the tritpans, most notably sumatriptan, may be successful at treating migraines and there is a dose-dependent effect.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Migraine headaches are a significant source of disability, with a prevalence of 1% to 3% in ages 3 to 7 years, 4% to 11% in ages 7 to 11 years, and 8% to 23% by the age of 15 years. 3,4 Disabilities experienced by children include the inability to get out of bed, poor performance in school, and the failure to attend school. [5][6][7] In addition, it has been suggested that migraines play a role in childhood depression.…”

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confidence: 99%

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

2016

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Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children

et al. 2018

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IMPORTANCE-Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing public health concern because epidemiologic data indicate a marked increase in the number of emergency department visits for mTBI over the past decade. However, no evidencebased clinical guidelines have been developed to date for diagnosing and managing pediatric mTBI in the United States.OBJECTIVE-To provide a guideline based on a previous systematic review of the literature to obtain and assess evidence toward developing clinical recommendations for health care professionals related to the diagnosis, prognosis, and management/treatment of pediatric mTBI. EVIDENCE REVIEW-The Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control Board of Scientific Counselors, a federal advisory committee, established the Pediatric Mild Traumatic Brain Injury Guideline Workgroup. The workgroup drafted recommendations based on the evidence that was obtained and assessed within the systematic review, as well as related evidence, scientific principles, and expert inference. This information includes selected studies published since the evidence review was conducted that were Lumba-Brown et al.

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Treatment of Pediatric Migraine in the Emergency Room

Cited by 29 publications

References 95 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

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

Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children

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