Treatment of pediatric migraine headaches: a randomized, double-blind trial of prochlorperazine versus ketorolac.
OBJECTIVE
We compare the effectiveness of intravenous ketorolac and intravenous prochlorperazine in the treatment of pediatric migraine headaches.


METHODS
We performed a prospective, randomized, double-blind clinical trial in 2 pediatric emergency departments (EDs) within children's hospitals. Children aged 5 to 18 years presenting to the ED with migraine headaches were eligible for the study. Contraindications to either medication or the inability to complete the pain score resulted in exclusion. Children were randomized to receive intravenous ketorolac (0.5 mg/kg; maximum 30 mg) or intravenous prochlorperazine (0.15 mg/kg; maximum 10 mg). All children also received a normal saline solution bolus. Successful treatment was defined as a 50% or greater reduction in the Nine Faces Pain Scale score at 60 minutes. If a less than 50% improvement occurred by 60 minutes, the child received the other medication. Forty-eight-hour follow-up telephone calls were made to each family to assess recurrence and late side effects.


RESULTS
Sixty-two children were enrolled: 33 initially received prochlorperazine, and 29 initially received ketorolac. By 60 minutes, 16 (55.2%) of 29 of those who received ketorolac and 28 (84.8%) of 33 of those who received prochlorperazine were successfully treated (difference=30%; 95% confidence interval [CI] 8% to 52%). Fifty-six (93.3%) of the 60 children who completed the study were successfully treated by the study's conclusion. Approximately 30% of each group had a recurrence of some headache symptoms. Only 2 children reported side effects, both mild and self-limited.


CONCLUSIONS
In children, intravenous prochlorperazine is superior to intravenous ketorolac in the acute treatment of migraine headaches.
Brousseau
David C
DC
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA. dbrousse@mail.mcw.edu
Duffy
Susan J
SJ
Anderson
Angela C
AC
Linakis
James G
JG
D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D000932:Antiemetics / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008881:Migraine Disorders / Q000188:drug therapy*; D010146:Pain / Q000188:drug therapy; D010147:Pain Measurement; D011346:Prochlorperazine / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000932:Antiemetics; D011346:Prochlorperazine; D020910:Ketorolac