Prochlorperazine in the treatment of migraine in children who present to the emergency department.
Date First Published:
June 27, 2007
Last Updated:
July 18, 2007
Report by:
Shabnam Rashid, Medical Student (Manchester Royal Infirmary)
Search checked by:
Kevin Mackway-Jones, Manchester Royal Infirmary
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
Embase 1980 to 2007 Week 26 using Ovid Interface
Search Details:
[(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)]
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):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Symptomatic treatment of migraine in children: a systematic review of medication trials. Damen L, Bruijn JK, Verhagen AP, Berger MY, Passachier J, Koes BW. 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. |
| Treatment of Paediatric Migraine Headaches: A Randomized, Double-Blind Trial of Prochlorperazine Versus Ketorolac. Brousseau DC, Duffy SJ, Anderson AC, Linakis JG. 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. | ||||
| Tolerability and effectiveness of prochlorperazine for intractable migraine in children. Kabbouche MA, Vockell AL, LeCates SL, Powers SW , Hershey AD. 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 |
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:
- Damen L, Bruijn JK, Verhagen AP, Berger MY, Passachier J, Koes BW.. Symptomatic treatment of migraine in children: a systematic review of medication trials.
- Brousseau DC, Duffy SJ, Anderson AC, Linakis JG.. Treatment of Paediatric Migraine Headaches: A Randomized, Double-Blind Trial of Prochlorperazine Versus Ketorolac.
- Kabbouche MA, Vockell AL, LeCates SL, Powers SW , Hershey AD.. Tolerability and effectiveness of prochlorperazine for intractable migraine in children.