IV Prochlorperazine Effective for Pediatric Primary Intractable Migraine

HONOLULU, HI—Intravenous (IV) prochlorperazine is more effective for the acute treatment of refractory migraine in pediatric patients than IV metoclopramide or valproate sodium. Shannon Cherney, MSN, CNP, from the Cincinnati Children's Hospital Medical Center, Cincinnati, OH, and colleagues sought to evaluate the efficacy of various IV pharmacotherapy options for primary intractable headache in children. The results were presented today at the American Pain Society's 31st Annual Scientific Meeting.

Pediatric headache affects more than 10% of children and exceed 20% in adolescents, the investigators noted. At the Cincinnati Children's Hospital Medical Center Emergency Department, headache is the third leading cause of referral; at 3.2%, this rate is twice that reported for adults. A pediatric infusion acute care unit was developed to treat pediatric patients with migraines refractory to home acute treatment instead of in the emergency department.

They conducted retrospective analyses of 818 visits of 500 patients who received treatment in the pediatric acute care infusion unit between September 2007 and May 2012. “Associated headache symptoms and characteristics, disability/pain scores, response rates, and effectiveness of therapies were reviewed,” noted Cherney.

Standardized treatment included IV D5 ½ NS 20mL/kg (maximum dose = 1,000mL) and prochlorperazine 0.15mg/kg (max dose = 10mg) or metoclopramide 0.25mg/kg (max = 20mg) or valproic acid 15mg/kg (max single dose = 1,000mg) and/or ketorolac 0.5mg/kg (2-16 years old, max dose = 15mg; >16 years old, max dose = 30mg).

Patient demographics showed a female:male ratio of 3.62:1 ; mean age of 15.18 ± 2.9 years; and a mean headache severity of 6.79 ± 2.7 on a 0–10 pain scale. Episodic baseline headache frequency (n=530) was 4.48 ± 3.6 days/month for patients who were episodic; chronic baseline headache frequency (n=267) was 26.23 ± 5.63 day/month for patients who were chronic. Medications administered were prochlorperazine (n=419), metoclopramide (n=341), valproate acid (n=55).

The percentage of patients that were headache free was 66% for prochlorperazine, 62% for metoclopramide, and 31% for valproate acid. For those patients receiving prochlorperazine and metoclopramide who were not headache free after therapy, mean posttreatment headache severity on a 0–10 scale was 3.84 ± 2.00 and 4.19 ± 2.51, respectively.

“A pediatric acute headache care unit offers more targeted therapies to refractory headache patients,” the investigators concluded. Further studies are needed to evaluate long-term benefit from treatment, they noted, especially 48 to 72 hours postdischarge.