Pediatric Migraine Treatment Practices Vary Widely in ER

Children seen for migraines represent failure of outpatient abortive efforts
By Lindsey Marcellin
HealthDay Reporter

WEDNESDAY, June 9 (HealthDay News) -- In a sample of Canadian emergency departments, children seen for migraine headaches reported frequent occurrence of attacks, and were subject to significant treatment variations by emergency department physicians, according to research published online June 7 in Pediatrics.

Lawrence P. Richer, M.D., of the University of Alberta in Edmonton, Canada, and colleagues performed a retrospective chart review of children seen in 10 Canadian pediatric emergency departments for migraine headache over a one-year period. They included 1,694 records in the study.

The researchers found the average age of the patients to be 12.1 years; 14.5 percent of them reported having a headache on more than 15 days per month. Almost two-thirds of the children had already used abortive treatment. Significant variations were noted in the use of all classes of migraine-abortive therapies in the emergency department, with dopamine receptor antagonists such as prochlorperazine used in 39 percent of patients, and oral analgesics such as acetaminophen and ibuprofen used in 24.5 percent. Factors which predicted use of evidence-based therapies included older age of the child and being discharged with a diagnosis of migraine (odds ratios, 1.15 and 1.84, respectively).

"Of the evidence-based medications, dopamine receptor antagonists were the most commonly used and included predominantly metoclopramide and prochlorperazine, but these medications have not been compared in children. The practice of using combinations of medications is common and warrants formal evaluation. Emergency physicians are uniquely positioned to intervene for this vulnerable population of patients, who generally present late in the course of a migraine attack, and a program of research is urgently required," the authors write.

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