Clinical outcomes of children treated with intravenous prochlorperazine for migraine in a pediatric emergency department.
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.


CONCLUSIONS
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.
Trottier
Evelyne D
ED
Division of Emergency Medicine, Université de Montréal, Montréal, Quebec, Canada.
Bailey
Benoit
B
Dauphin-Pierre
Sabine
S
Gravel
Jocelyn
J
D000293:Adolescent; D002648:Child; D004155:Diphenhydramine / Q000008:administration & dosage*; D018492:Dopamine Antagonists / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D008485:Medical Audit; D008881:Migraine Disorders / Q000188:drug therapy*; D010147:Pain Measurement; D011346:Prochlorperazine / Q000008:administration & dosage*; D012189:Retrospective Studies; D017211:Treatment Failure
D018492:Dopamine Antagonists; D006993:Hypnotics and Sedatives; D004155:Diphenhydramine; D011346:Prochlorperazine