Oral metoclopramide for pediatric migraine management in the ED: health records review.

objectivesMigraine is a common presentation in pediatric emergency departments (ED), and non-invasive treatment options are desirable. This study evaluated what proportion of children treated with oral metoclopramide would not need a rescue medication for the treatment of migraine in the ED.

methodsWe conducted a retrospective cohort study at a tertiary pediatric ED in Montréal, Canada, over a one-year period. Patients aged 8-18 years diagnosed with migraine and treated with either oral or intravenous metoclopramide were included. The primary outcome was headache relief, defined as no need for rescue medication. Secondary outcomes included ED length of stay, adverse events, return visits within 7 days, and reduction in pain scores measured by the 10-point verbal numeric rating scale. The primary analysis was the proportion of children who did not need a rescue medication restricted to children treated with oral metoclopramide. Secondary exploratory analyses compared oral to intravenous administrations on primary and secondary outcomes.

resultsOf the 225 patients included, 78 received oral and 147 received intravenous metoclopramide. Headache relief was achieved in 83% (95% CI 73-91%) of the oral group. This compared favorably to the intravenous group (difference: 4%; 95% CI -7 to 14%). ED length of stay was shorter in the oral group (median 314 vs 500 min). Adverse events occurred only in the intravenous group (4%) and return visit proportions were similar between groups (difference 2%; 95% CI - 6 to 12%).

conclusionsOral metoclopramide is an effective and well-tolerated treatment for 80% of children with migraine in the ED. On exploratory evaluation, it offered comparable outcomes to intravenous administration with the added benefits of shorter ED stays and reduced procedural pain. Oral metoclopramide should be considered as a first-line treatment option for pediatric migraine in the emergency department.