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Prochlorperazine in children with migraine: a look at its effectiveness and rate of akathisia
Evelyne D Trottier1, Benoit Bailey, Nathalie Lucas
1Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Montréal, Quebec, Canada H3T 1C5.
Insights
Prochlorperazine effectively reduces severe migraine pain in children short-term. However, many experience relapse within a week, and akathisia remains a concern despite diphenhydramine use.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Pharmacology
Background:
- Severe migraine significantly impacts children's quality of life.
- Effective acute treatment options for pediatric migraine in emergency settings are crucial.
Purpose of the Study:
- To assess the efficacy of prochlorperazine in alleviating severe migraine pain in pediatric patients.
- To determine the incidence rate of akathisia associated with prochlorperazine treatment in children.
Main Methods:
- Prospective cohort study of pediatric patients (<18 years) with severe migraine.
- Intravenous prochlorperazine with diphenhydramine administered in the emergency department.
- Pain and akathisia assessed pre-treatment, post-treatment, and via telephone follow-up.
Main Results:
- Prochlorperazine achieved a 50% pain reduction in 100% of patients and pain-free status in 50% at discharge.
- Treatment failure occurred in 22% of patients.
- A high rate of headache relapse (68%) was observed within the first week post-discharge.
- Akathisia was definitively diagnosed in 5% of patients, with possible symptoms in 34%.
Conclusions:
- Prochlorperazine demonstrates short-term effectiveness for severe pediatric migraine pain.
- High relapse rates necessitate strategies for sustained pain management.
- Akathisia is a significant adverse event to monitor, even with concurrent diphenhydramine administration.
Objective:
The objective of this study is to evaluate the effectiveness of prochlorperazine and the rate of akathisia in children with severe migraine.
Methods:
The study is a prospective cohort of a convenient sample of patients younger than 18 years old diagnosed with migraine and treated with intravenous prochlorperazine in adjunction with diphenhydramine in the emergency department. The evaluation of pain and akathisia was performed before the treatment and was repeated 60 minutes later and before discharge. A telephone follow-up was completed to assess relapse in pain and presence of akathisia. The effectiveness of prochlorperazine was determined using different outcomes: 50% reduction of pain, pain-free patients, treatment failure, and relapse of pain.
Results:
Of the 79 patients included in the study for 25 months, 64 (81%) either met the International Headache Society criteria or had a diagnosis of migraine confirmed by a neurologist at follow-up. Among these patients, 47 (100%) of 47 had a 50% reduction of pain, and 24 (50%) of 48 were pain free at discharge. Only 14 (22%) of 64 patients had a treatment failure. However, 43 (68%) of 63 patients had a relapse of their headache within the first week after discharge. Overall, among the 79 patients, 4 (5%) had a definitive diagnosis of akathisia, but 27 (34%) other patients presented symptoms suggesting a possible diagnosis of akathisia.
Conclusion:
Prochlorperazine seems very effective to decrease pain on a short-term basis in children. However, more than two thirds of the patients, overall, had a relapse of their migraine at home in the first week. Despite the use of diphenhydramine, akathisia remains a concern.
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