title: QTc Prolongation in Acute Pediatric Migraine.
abstract: OBJECTIVE
  Migraine headache is common in pediatrics and is frequently assessed in emergency departments. Altered cardiac conduction, including prolongation of the QTc interval on electrocardiogram, has been observed in adults during migraine headache and resolves interictally. Prolonged QTc is associated with life-threatening arrhythmia, and many acute and prophylactic therapies for migraine can further prolong the QTc interval. It is the objective of this prospective cohort study to examine whether the QTc interval prolongs significantly during periods of acute migraine headache in children.
  
  
  METHODS
  Patients ages 6 to 17 years presenting to the emergency department with acute migraine headache were recruited prospectively. Exclusion criteria included the use of QTc-prolonging medications and medical illnesses, including cardiovascular abnormalities, infection, or head injury. Paired, one-tailed Student t tests compared QTc intervals with and without headache and evaluated for QTc prolongation of 30 ms or longer during headache.
  
  
  RESULTS
  Thirteen patients with migraine (mean age, 11.6 ± 2.6 years) were evaluated. Mean QTc interval during headache was significantly longer than the QTc interval in the absence of headache (437.9 ± 27.7 ms compared with 419.3 ± 29.9 ms; p = 0.04). Three patients (23%) had unequivocal prolongation of the QTc (>460 ms) during the migraine, two of which normalized with headache resolution. The mean increase in QTc during headache did not reach or exceed 30 ms (p = 0.86) CONCLUSIONS: This study is the first to illustrate a connection between QTc prolongation and acute migraine headache in children. If confirmed in future studies, children should be monitored for QTc prolongation during the acute treatment of migraine in the emergency department when using medications that can lengthen the QTc interval.
authors.affiliation: From the *Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; †Department of Pediatrics; ‡Division of Pediatric Neurology, Department of Pediatrics, Alberta's Children Hospital; §Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; and ∥Division of Pediatric Cardiology, Department of Pediatrics, Alberta's Children Hospital, Calgary, Alberta, Canada.
authors.forename: Lindsay J
authors.initials: LJ
authors.lastname: May
authors.forename: Kelly
authors.initials: K
authors.lastname: Millar
authors.forename: Karen M
authors.initials: KM
authors.lastname: Barlow
authors.forename: Frank
authors.initials: F
authors.lastname: Dicke
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008133:Long QT Syndrome / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008881:Migraine Disorders / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D011446:Prospective Studies; D014363:Tryptamines / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D014363:Tryptamines