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Treatment of childhood headache with dihydroergotamine mesylate
1Dallas Pediatric Neurology Associates, TX 75243-1708.
Insights
Pediatric migraine patients unresponsive to standard treatments showed an 80% response rate to an inpatient protocol using intravenous dihydroergotamine mesylate (DHE) and metoclopramide, with minimal side effects.
Area of Science:
- Neurology
- Pediatric Medicine
- Clinical Pharmacology
Background:
- Pediatric migraine without aura can be refractory to standard outpatient treatments.
- Intravenous dihydroergotamine mesylate (DHE) and metoclopramide are used in adult protocols but require specific evaluation in pediatric populations.
- Identifying effective inpatient strategies is crucial for managing difficult-to-treat pediatric migraines.
Purpose of the Study:
- To assess the efficacy of an inpatient treatment protocol for pediatric patients with migraine without aura who failed prior outpatient therapies.
- To evaluate the response rate and safety of intravenous DHE combined with oral metoclopramide in this specific patient group.
Main Methods:
- An open-label, retrospective review was conducted on thirty pediatric patients.
- Patients received an inpatient treatment protocol involving intravenous DHE and oral metoclopramide.
- Dosage of DHE mesylate ranged from 0.1 to 0.5 mg, with an average of five doses administered.
Main Results:
- Eighty percent of pediatric patients demonstrated a positive response to the inpatient protocol.
- Treatment success was observed irrespective of the duration of the refractory migraine.
- Minimal side effects were reported during the treatment course.
Conclusions:
- The inpatient protocol of intravenous DHE and metoclopramide is an effective treatment for pediatric migraine without aura refractory to standard care.
- Lower doses of DHE mesylate may be sufficient and well-tolerated in pediatric patients compared to adult protocols.
- This approach offers a viable option for managing complex pediatric migraine cases.
Abstract:
This study was undertaken to determine whether pediatric patients with migraine without aura who have failed standard outpatient regimens including intravenous dihydroergotamine mesylate (DHE) in conjunction with oral metoclopramide would respond to an inpatient treatment protocol of intravenous DHE and oral metoclopramide. Thirty patients were evaluated in this study which was an open label, retrospective review of treatment. Independent of the duration of the refractory migraine, 80% of the patients responded to the protocol with only minimal side effect. The dose of DHE mesylate ranged from 0.1 to 0.5 mg. The dose of DHE is lower than is typically utilized in standard adult protocols. The patients received an average of five doses of DHE.