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Intravenous migraine therapy in children with posttraumatic headache in the ED
Steven Chan1, Brad Kurowski2, Terri Byczkowski1
1Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Insights
Intravenous migraine therapy effectively reduced pain in children with posttraumatic headache (PTH) following mild traumatic brain injury (mTBI). This treatment showed significant success in emergency department settings, offering rapid pain relief for young patients.
Area of Science:
- Pediatric Emergency Medicine
- Neuroscience
- Clinical Pharmacology
Background:
- Millions of children experience traumatic brain injuries annually, often resulting in posttraumatic headache (PTH).
- Current emergency department (ED) treatments for pediatric PTH are inconsistent, with unclear efficacy.
Purpose of the Study:
- To evaluate the effectiveness of intravenous migraine therapy in reducing pain scores for children with PTH.
- To identify factors influencing treatment response in pediatric patients with PTH.
Main Methods:
- Retrospective analysis of 254 children (8-21 years) with mild traumatic brain injury (mTBI) and PTH treated between 2009-2013.
- Inclusion criteria: mTBI within 14 days of ED visit, headache, and administration of IV ketorolac, prochlorperazine, metoclopramide, chlorpromazine, or ondansetron.
- Primary outcome: treatment success defined as ≥50% pain reduction; logistic regression used to identify predictors of success.
Main Results:
- 86% of patients achieved treatment success, with 52% experiencing complete headache resolution.
- Patients undergoing head CT imaging were less likely to respond to treatment (80% vs. 91%, P = .008).
- Mean age was 13.8 years, 51% female, 80% white, and mean time since injury was 2 days.
Conclusions:
- Intravenous migraine therapy is an effective treatment for reducing PTH pain in children within 14 days of mTBI.
- Further research is necessary to establish the long-term benefits of acute PTH management in the ED.
Background:
More than 3.8 million children sustain traumatic brain injuries annually. Treatment of posttraumatic headache (PTH) in the emergency department (ED) is variable, and benefits are unclear.
Objective:
The objective of the study is to determine if intravenous migraine therapy reduces pain scores in children with PTH and factors associated with improved response.
Methods:
This was a retrospective study of children, 8 to 21 years old, presenting to a tertiary pediatric ED with mild traumatic brain injury (mTBI) and PTH from November 2009 to June 2013. Inclusion criteria were mTBI (defined by diagnosis codes) within 14 days of ED visit, headache, and administration of one or more intravenous medications: ketorolac, prochlorperazine, metoclopramide, chlorpromazine, and ondansetron. Primary outcome was treatment success defined by greater than or equal to 50% pain score reduction during ED visit. Bivariate analysis and logistic regression were used to determine predictors of treatment success: age, sex, migraine or mTBI history, time since injury, ED head computed tomographic (CT) imaging, and pretreatment with oral analgesics.
Results:
A total of 254 patients were included. Mean age was 13.8 years, 51% were female, 80% were white, mean time since injury was 2 days, and 114 patients had negative head CTs. Eighty-six percent of patients had treatment success with 52% experiencing complete resolution of headache. Bivariate analysis showed that patients who had a head CT were less likely to respond (80% vs 91%; P = .008).
Conclusions:
Intravenous migraine therapy reduces PTH pain scores for children presenting within 14 days after mTBI. Further prospective work is needed to determine long-term benefits of acute PTH treatment in the ED.
