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Effectiveness of Standardized Combination Therapy for Migraine Treatment in the Pediatric Emergency Department
Author(s) -
Leung Stephanie,
Bulloch Blake,
Young Christine,
Yonker Marcy,
Hostetler Mark
Publication year - 2013
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.12042
Subject(s) - medicine , emergency department , migraine , prochlorperazine , confidence interval , population , pediatrics , physical therapy , anesthesia , emergency medicine , nausea , environmental health , psychiatry
Objective To compare outcomes of pediatric migraine patients treated in an emergency department ( ED ) before and after implementation of a standardized combination intravenous therapy regimen aimed toward improving and standardizing abortive migraine therapy. Background In a pediatric ED , migraines represent 8‐18% of all headache visits. Despite this large number, no standard treatment for acute migraine therapy currently exists. Methods The study utilized a retrospective chart review of patients seeking acute migraine treatment at a tertiary care, pediatric ED from August 2006 to March 2010. Inclusion criteria were pediatric migraine patients as defined by I nternational H eadache Society guidelines. The comparison population received various migraine therapies based on attending practice preference. After October 2008, patients received standardized intravenous combination therapy involving a normal saline fluid bolus, ketorolac, prochlorperazine, and diphenhydramine. Occasionally, metoclopramide was substituted during prochlorperazine shortages. Reduction in headache pain score was the primary outcome. Secondary outcome measures included length of ED stay, hospital admission rate, and ED readmission rate within 48 hours. Results The study yielded 87 patients who received standardized combination therapy and 165 comparison patients. No significant difference in patient characteristics existed when evaluating patient demographics, outpatient medication use, and initial headache pain score. When compared with the non‐standardized therapy population, the combination therapy patients revealed significant reductions in pain score (decrease of 5.3 vs 6.9, difference −1.6, 95% confidence interval −2.2 to −0.8, P < .001), length of ED stay (5.3 vs 4.4 hours, difference 0.9, 95% confidence interval 0.2‐1.6, P = .008), and hospital admission rate (32% vs 3%, P < .001) without changes in ED return rate (7% vs 2%, P = .148). Conclusion Standardized combination therapy is effective for acute pediatric migraine therapy in the ED by significantly reducing headache pain scores, length of ED stay, and hospital admission rates.