title: A comparison of acute treatment regimens for migraine in the emergency department.
abstract: OBJECTIVE
  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 (2009-2012). 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.
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts richard.bachur@childrens.harvard.edu.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Bachur
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Monuteaux
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Mark I
authors.initials: MI
authors.lastname: Neuman
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D057186:Comparative Effectiveness Research; D004155:Diphenhydramine / Q000009:adverse effects / Q000627:therapeutic use*; D018492:Dopamine Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008787:Metoclopramide / Q000009:adverse effects / Q000627:therapeutic use; D008881:Migraine Disorders / Q000188:drug therapy*; D016017:Odds Ratio; D017294:Ondansetron / Q000009:adverse effects / Q000627:therapeutic use*; D010359:Patient Readmission; D011346:Prochlorperazine / Q000009:adverse effects / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D014363:Tryptamines / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D018492:Dopamine Antagonists; D014363:Tryptamines; D017294:Ondansetron; D004155:Diphenhydramine; D008787:Metoclopramide; D011346:Prochlorperazine
keywords: emergency; headache; migraine; therapeutics