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The Use of a Pediatric Migraine Practice Guideline in an Emergency Department Setting
Courtney R J Kaar1, James M Gerard, Albert K Nakanishi
1From the Department of Pediatrics, Division of Emergency Medicine, Saint Louis University School of Medicine, Saint Louis, MO.
Insights
A pediatric migraine practice guideline (MCPG) effectively reduced pain in children presenting to the emergency department (ED). This standardized protocol demonstrated clinical safety and efficacy, with no adverse events reported in the study population.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Clinical Practice Guidelines
Background:
- Migraine headaches are a common cause of pediatric emergency department visits.
- Standardized treatment protocols are lacking in the pediatric emergency setting.
- Evidence-based guidelines are crucial for consistent and effective care.
Purpose of the Study:
- To evaluate the safety and efficacy of a standardized pediatric migraine practice guideline (MCPG).
- To assess the impact of the MCPG on pain reduction and emergency department length of stay.
- To contribute data on migraine treatment protocols in pediatric emergency care.
Main Methods:
- Development of the Migraine Clinical Practice Guideline (MCPG) based on evidence-based data.
- Implementation of the MCPG for pediatric patients with severe migraine pain (VPS > 6).
- Chart review of 266 patients treated under the MCPG, analyzing pain scores, adverse events, and admission rates.
Main Results:
- The MCPG resulted in a 73% reduction in pain (mean VPS from 7.8 to 2.1).
- No adverse events were identified in patients treated with the MCPG.
- A small percentage of patients (7.5%) were admitted for status migrainosus.
Conclusions:
- The standardized pediatric migraine practice guideline is clinically safe and effective.
- The MCPG offers a valuable treatment protocol for acute pediatric migraines in the ED.
- Further prospective and comparative studies are recommended to validate the protocol's effectiveness.
Objective:
The aim of the study was to evaluate the safety and efficacy of a standardized pediatric migraine practice guideline in the emergency department (ED).
Methods:
Migraine Clinical Practice Guideline (MCPG) was created in collaboration with the Division of Pediatric Neurology and Pediatric Emergency Medicine. The MCPG was established on evidence-based data and best practice after a review of the literature. The MCPG was implemented for patients with a known diagnosis of migraine headaches and a verbal numeric pain score (VPS) greater than 6 on a 0 to 10 scale. Patients received intravenous saline, ketorolac, diphenhydramine, and either metoclopramide or prochlorperazine. After 40 minutes, another VPS was obtained, and if no improvement, a repeat dose of metoclopramide or prochlorperazine was administered. If after 40 minutes and minimal pain relief occurred, a consult to neurology was made. A chart review of patients enrolled in the MCPG from April 2004 to April 2013 was conducted. We recorded demographic data, vital signs, ED length of stay, initial VPS, last recorded VPS, adverse events, and admission rate. Nonparametric statistics were performed.
Results:
A total of 533 charts were identified with a discharge diagnosis of migraine headache of which 266 were enrolled in the MCPG (179 females and 87 males). Mean (SD) age was 13.9 (3.1). Mean (SD) initial VPS was 7.8 (2.0). Mean (SD) discharge VPS was 2.1 (2.8), representing a 73% reduction of pain. Twenty patients (7.5%) were admitted for status migrainosus; mean (SD) age was 14.0 (3.5) years and mean (SD) VPS was 6.3 (2.8). Mean (SD) length of stay in ED was 283 (107) minutes. No adverse events were identified.
Conclusions:
Our MCPG was clinically safe and effective in treating children with acute migraine headaches. Our data add to the dearth of existing published literature on migraine treatment protocols in the ED setting. We recommend additional prospective and comparative studies to further evaluate the effectiveness of our protocol in this patient population.
