HONOLULU, HI—Intravenous(IV) prochlorperazine is more effective for the acute treatment of refractorymigraine in pediatric patients than IV metoclopramide or valproate sodium. ShannonCherney, MSN, CNP, from the Cincinnati Children’s HospitalMedical Center,Cincinnati, OH, and colleagues sought to evaluate theefficacy of various IV pharmacotherapy options for primary intractable headachein children. The results were presented today at the American Pain Society’s 31stAnnual Scientific Meeting.
Pediatric headache affectsmore than 10% of children and exceed 20% in adolescents, the investigatorsnoted. At the Cincinnati Children’s Hospital Medical Center EmergencyDepartment, headache is the third leading cause of referral; at 3.2%, this rateis twice that reported for adults. A pediatric infusion acute care unit wasdeveloped to treat pediatric patients with migraines refractory to home acutetreatment instead of in the emergency department.
They conductedretrospective analyses of 818 visits of 500 patients who received treatment inthe 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 treatmentincluded IV D5 ½ NS 20mL/kg (maximum dose = 1,000mL) and prochlorperazine0.15mg/kg (max dose = 10mg) or metoclopramide 0.25mg/kg (max = 20mg) orvalproic 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 demographicsshowed a female:male ratio of 3.62:1 ; mean age of 15.18 ± 2.9 years; and amean headache severity of 6.79 ± 2.7 on a 0–10 pain scale. Episodic baselineheadache frequency (n=530) was 4.48 ± 3.6 days/month for patients who wereepisodic; chronic baseline headache frequency (n=267) was 26.23 ± 5.63 day/monthfor patients who were chronic. Medications administered were prochlorperazine(n=419), metoclopramide (n=341), valproate acid (n=55).
The percentage of patientsthat were headache free was 66% for prochlorperazine, 62% for metoclopramide,and 31% for valproate acid. For those patients receiving prochlorperazine andmetoclopramide who were not headache free after therapy, mean posttreatmentheadache severity on a 0–10 scale was 3.84 ± 2.00 and 4.19 ± 2.51,respectively.
“Apediatric acute headache care unit offers more targeted therapies to refractoryheadache patients,” the investigators concluded. Further studies are needed toevaluate long-term benefit from treatment, they noted, especially 48 to 72hours postdischarge.