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Three Part Question

In [children who present to the emergency department] is [Prochlorperazine] useful in the [treatment of migraine].

Clinical Scenario

A 12 year old child comes to the emergency department accompanied by her mother. The child complains of a severe throbbing headache which started an hour ago but is still present. She has also vomited once in the last 30 minutes. She has had this headache once before last week but did not attend the emergency department. After taking the history and doing the clinical examination you diagnose the child as having migraine. You wonder whether Prochlorperazine is useful in treating the childs migraine.

Search Strategy

Medline 1950- June 2007 using Ovid Interface
Embase 1980 to 2007 Week 26 using Ovid Interface
[(exp headache OR exp migraine disorders OR exp migraine OR exp migraine without aura OR exp migraine with aura OR exp migraine aura) AND (exp prochlorperazine OR exp prochlorperazine maleate OR exp antiemetic agent) AND (LIMIT to children AND english)]

Search Outcome

10 papers were identified on Medline of which 3 were relevant and 20 papers were identified on Embase but none were relevant.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Damen L et al, 2005 Netherlands	10 trials reviewed, only 1 useful. Patients <18 years old	Systemic review on randomised and controlled trials.	Reduction of symptoms after 1 hour	IV Prochlorperazine was more effective than IV Ketorolac in reduction of symptoms 1 hour after treatment.	Complete follow up was not obtained on 6 children. No placebo was used therefore unable to comment on drug affect alone.
Brousseau DC et al, 2004 USA	62 children aged 5-18 years old	Prospective randomised double blind clinical trials	% of patients successfully treated by 60 minutes	55.2% who received Ketorolac and 33% of those who received Prochlorperazine	Complete follow up not obtained on 6 children. No placebo was used therefore unable to comment about drug affect alone
			Side effects	2 children who received Prochlorperazine experienced mild side effects. No side effects reported with Ketorolac.
			Headache reoccurance at follow up	No difference in patients who received Prochlorperazine and Ketorolac.
			Pain score	Greater number of children reported lower pain score with Prochlorperazine compared with Ketorolac.
Kabbouche MA et al, 2001 Ohio	Children evaluated at headache center in childrens hospital	Retrospective review of patients who received IV Prochlorperazine	% of patients which felt better	90% 1 hour after treatment with Prochlorperazine	No placebo was used in the study therefore unable to comment on drug affect alone.
			% of patients who were pain free	50% at 1 hour, 60% at 3 hours
			Reduction in severity	75% at 1 hour, 95% at 3 hours
			Failure	1 patient failed to respond to Prochlorperazine

Clinical Bottom Line

Prochlorperazine belongs to a class of drugs called phenothiazines. Prochlorperazine is normally given to patients who experience nausea and vomiting. There were no studies confirming whether this drug was beneficial for treating migraine in patients with/without nausea and vomiting. However, the studies did report that over 50% of patients became pain free or improved 1 hour after treatment with Prochlorperazine. Side effects of Prochlorperazine were mild and only a few patients experienced side effects. Therefore, in conclusion Prochlorperazine is useful in treating/ decreasing the pain in migraine.

References

1. Damen L, Bruijn JK, Verhagen AP, Berger MY, Passachier J, Koes BW. Symptomatic treatment of migraine in children: a systematic review of medication trials. Pediatrics 295-302, 2005 August.
2. Brousseau DC, Duffy SJ, Anderson AC, Linakis JG. Treatment of Paediatric Migraine Headaches: A Randomized, Double-Blind Trial of Prochlorperazine Versus Ketorolac. Annals of Emergency Medicine 256-262, 2004 February
3. Kabbouche MA, Vockell AL, LeCates SL, Powers SW , Hershey AD. Tolerability and effectiveness of prochlorperazine for intractable migraine in children. Pediatrics 107(4):E62, 2001 April.