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Enhancing Outpatient Dihydroergotamine Infusion With Interdisciplinary Care to Treat Refractory Pediatric Migraine: Preliminary Outcomes From the Comprehensive Aggressive Migraine Protocol (“CAMP”)
Author(s) -
Connelly Mark,
Sekhon Subhjit,
Stephens Dane,
Boorigie Madeline,
Bickel Jennifer
Publication year - 2020
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.13685
Subject(s) - medicine , dihydroergotamine , migraine , migraine treatment , refractory (planetary science) , physical therapy , massage , anesthesia , ambulatory care , health care , alternative medicine , physics , pathology , astrobiology , economics , economic growth
Objective To determine preliminary outcomes of a treatment for refractory pediatric migraine that integrates outpatient dihydroergotamine (DHE) infusion with interdisciplinary adjunctive care. Background Limited data are available to inform treatment of refractory migraine in children. Intravenous DHE therapy has shown promise but has been implemented in costly inpatient settings and in isolation of nonpharmacological strategies shown to enhance analgesia and functional improvement. Methods We conducted a retrospective chart review of 36 patients ages 11‐18 with refractory migraine who underwent a pilot treatment program in an outpatient neurology clinic. The treatment integrated up to 5 days of outpatient DHE infusion with adjunctive nonpharmacological care (pain coping skills training, massage, aromatherapy, and school reintegration support). Changes in headache, healthcare utilization, and functional limitations were assessed as indicators of treatment response through 3‐month follow‐up. Results On average, headache intensity declined (M = 5.8 ± 2.5 to M = 2.4 ± 2.7; P < .0001) during the treatment period and remained statistically significantly improved through 3‐month follow‐up. Headache frequency decreased by a mean of 1.5 days per week (M = 6.7 ± 1.0 vs M = 5.2 ± 2.7, P = .012) through 3‐month follow‐up, with a 27% reduction (from 0.91 to 0.66) in the proportion of patients reporting a continuous headache ( P = .009). Over this same follow‐up period, there was a reduction in school days missed per month (median [25th, 75th percentile]: 4.5 [0, 21.0] vs 0 [0.0, 0.5]). There also were reductions in headache‐related visits per month to the emergency department and medical providers. Adverse effects were common but typically minor and transient. Conclusions Combining outpatient DHE infusion with interdisciplinary adjunctive care has promise as an effective treatment option for adolescents with refractory migraine.