Effectiveness of Standard Combination Therapy in Pediatric Migraine

Pediatr Neurol. 2021 Mar:116:68-73. doi: 10.1016/j.pediatrneurol.2020.12.004. Epub 2020 Dec 16.

Abstract

Background: A combination of parenteral medications (often referred to as standard combination therapy) is frequently used in the treatment of acute migraine in the pediatric emergency department (PED). The primary aim of this study was to evaluate the two-hour, 24-hour, and seven-day impact of one such regimen on pain in children who present to the PED. Standard combination therapy for purposes of our study is defined as a bolus of intravenous saline, and a combination of intravenous ketorolac, prochlorperazine, and diphenhydramine.

Methods: This prospective observational study included 120 children between the ages seven and 18 years who presented to the PED with migraine, whose parents could read and understand the consent form in English, and who were treated with standard combination therapy. The primary outcome measure for this study was the change in severity of pain as noted by the child using the Faces Pain Scale-Revised. We analyzed normally distributed continuous variables by mean and standard deviation, whereas non-normally distributed continuous variables are reported by median and interquartile range.

Results: Nonparametric Friedman testing on the entire cohort (n = 120) noted that there was a statistically significant change in the Faces pain scale from before administration of standard combination therapy to the two-hour, 24-hour, and one-week time point with a reduction in pain score of 87.5%, 100%, and 50%, respectively, at the three time points.

Conclusions: This study noted moderate relief of pain after administration of standard combination therapy, which persisted at one-week after administration.

Keywords: Faces pain scale; Pediatric emergency department; Pediatric migraine; Standard combination therapy.

Publication types

  • Observational Study

MeSH terms

  • Acute Disease
  • Adolescent
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / pharmacology*
  • Child
  • Diphenhydramine / administration & dosage
  • Diphenhydramine / pharmacology*
  • Dopamine Antagonists / administration & dosage
  • Dopamine Antagonists / pharmacology*
  • Drug Therapy, Combination
  • Female
  • Humans
  • Hypnotics and Sedatives / administration & dosage
  • Hypnotics and Sedatives / pharmacology*
  • Ketorolac / administration & dosage
  • Ketorolac / pharmacology*
  • Male
  • Migraine Disorders / drug therapy*
  • Outcome Assessment, Health Care
  • Prochlorperazine / administration & dosage
  • Prochlorperazine / pharmacology*
  • Prospective Studies
  • Saline Solution / administration & dosage

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Dopamine Antagonists
  • Hypnotics and Sedatives
  • Saline Solution
  • Diphenhydramine
  • Prochlorperazine
  • Ketorolac