title: Relative Effectiveness of Dopamine Antagonists for Pediatric Migraine in the Emergency Department.
abstract: OBJECTIVE
  Migraine headaches are common in the pediatric emergency department. The mainstay of abortive treatment consists of nonsteroidal anti-inflammatories and dopamine antagonists. The objective of this study was to compare the effectiveness of 3 commonly used dopamine antagonists to abort pediatric migraine.
  
  
  METHODS
  This was a retrospective cohort study of all patients who presented to the pediatric emergency department at a tertiary care pediatric hospital between January 2010 and December 2013. Patients were treated for a migraine headache with a combination of ketorolac and one of the following dopamine antagonists: prochlorperazine, metoclopramide, or promethazine. The primary outcome was treatment failure and receiving non-evidence-based treatment defined by the need for opioids. Secondary outcomes included pain score reduction and return visit within 48 hours.
  
  
  RESULTS
  There were 57 patients during this period with 67 visits that met inclusion criteria: 27 (40.3%) visits in which patients were treated with prochlorperazine, 23 (34.3%) visits in which patients were treated with metoclopramide, and 17 (25.4%) visits in which patients were treated with promethazine. Across visits, the mean age was 14.5 years, and 63% were women. Opioids were given for treatment failure in 8.7% of visits in which patients received prochlorperazine, 25% in which patients received metoclopramide, and 42.8% in which patients received promethazine. Patients treated with promethazine had significantly higher odds of needing opioids and experiencing less than 50% reduction in pain score compared with prochlorperazine after adjusting for patient characteristics.
  
  
  CONCLUSIONS
  This study suggests variable efficacy among 3 commonly used dopamine antagonists for pediatric migraine headache. Promethazine seems least effective and results in higher use of opioids compared with other available dopamine antagonists.
authors.forename: David C
authors.initials: DC
authors.lastname: Sheridan
authors.forename: Amber
authors.initials: A
authors.lastname: Laurie
authors.forename: Stephanie
authors.initials: S
authors.lastname: Pacheco
authors.forename: Rongwei
authors.initials: R
authors.lastname: Fu
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Hansen
authors.forename: O John
authors.initials: OJ
authors.lastname: Ma
authors.forename: Garth D
authors.initials: GD
authors.lastname: Meckler
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D018492:Dopamine Antagonists / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000627:therapeutic use; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use*; D008881:Migraine Disorders / Q000188:drug therapy*; D010147:Pain Measurement; D011346:Prochlorperazine / Q000627:therapeutic use*; D011398:Promethazine / Q000627:therapeutic use*; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D018492:Dopamine Antagonists; D011398:Promethazine; D008787:Metoclopramide; D011346:Prochlorperazine; D020910:Ketorolac