title: Prochlorperazine in children with migraine: a look at its effectiveness and rate of akathisia.
abstract: OBJECTIVE
  The objective of this study is to evaluate the effectiveness of prochlorperazine and the rate of akathisia in children with severe migraine.
  
  
  METHODS
  The study is a prospective cohort of a convenient sample of patients younger than 18 years old diagnosed with migraine and treated with intravenous prochlorperazine in adjunction with diphenhydramine in the emergency department. The evaluation of pain and akathisia was performed before the treatment and was repeated 60 minutes later and before discharge. A telephone follow-up was completed to assess relapse in pain and presence of akathisia. The effectiveness of prochlorperazine was determined using different outcomes: 50% reduction of pain, pain-free patients, treatment failure, and relapse of pain.
  
  
  RESULTS
  Of the 79 patients included in the study for 25 months, 64 (81%) either met the International Headache Society criteria or had a diagnosis of migraine confirmed by a neurologist at follow-up. Among these patients, 47 (100%) of 47 had a 50% reduction of pain, and 24 (50%) of 48 were pain free at discharge. Only 14 (22%) of 64 patients had a treatment failure. However, 43 (68%) of 63 patients had a relapse of their headache within the first week after discharge. Overall, among the 79 patients, 4 (5%) had a definitive diagnosis of akathisia, but 27 (34%) other patients presented symptoms suggesting a possible diagnosis of akathisia.
  
  
  CONCLUSIONS
  Prochlorperazine seems very effective to decrease pain on a short-term basis in children. However, more than two thirds of the patients, overall, had a relapse of their migraine at home in the first week. Despite the use of diphenhydramine, akathisia remains a concern.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Montréal, Quebec, Canada H3T 1C5.
authors.forename: Evelyne D
authors.initials: ED
authors.lastname: Trottier
authors.forename: Benoit
authors.initials: B
authors.lastname: Bailey
authors.forename: Nathalie
authors.initials: N
authors.lastname: Lucas
authors.forename: Anne
authors.initials: A
authors.lastname: Lortie
mesh_terms: D000293:Adolescent; D017109:Akathisia, Drug-Induced / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D004155:Diphenhydramine / Q000627:therapeutic use; D018492:Dopamine Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008881:Migraine Disorders / Q000150:complications / Q000188:drug therapy*; D011346:Prochlorperazine / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D018492:Dopamine Antagonists; D006993:Hypnotics and Sedatives; D004155:Diphenhydramine; D011346:Prochlorperazine