Effectiveness of Intravenous Dihydroergotamine for Pediatric Headache: Does Headache Diagnosis Matter? (P4.135)

Objective: The aim of this study was to examine whether effectiveness of intravenous (IV) dihydroergotamine (DHE) varies by headache diagnosis. Background: DHE is an effective medication for many patients with intractable, acute pediatric headache, but anecdotal experience suggests it may not be equally effective in different headache types. Design/Methods: This study was a retrospective review of inpatients at the Children’s Hospital of Philadelphia who received IV DHE between January 2014 and July 2016. Data has so far been collected for 106 of the 194 subjects identified. Data was extracted from the chart, stored in RedCap, and analyzed with Stata. Subjects were included if their diagnosis was new onset headache (NOH) of 3mo), episodic migraine with status migrainosus (EM), or chronic migraine with status migrainosus (CM). Patients with cluster headache, post-concussive headache, chronic migraine with constant pain admitted for treatment of baseline pain, other headache types, and repeat admissions were excluded. Results: Of the 106 subjects, 92 had NOH, EM, or CM. There was a trend toward greater improvement after DHE for subjects with EM and CM compared to NOH. The median difference between admission and discharge pain scores was 3 points for NOH, 7 for EM, and 5 for CM (p=0.12). A smaller portion of NOH subjects (36%) were discharged with resolution of acute headache than patients with EM (55%) or CM (71%) (p=0.083). Of note, comorbid pain diagnoses were more common in subjects with CM (41%) than EM (17%) or NOH (0%) (p=0.005). Conclusions: The trend toward decreased effectiveness of DHE for NOH and the greater prevalence of comorbid pain diagnoses among subjects with CM suggest pathophysiologic differences between these headache types. Additional treatments are needed for patients with NOH. Disclosure: Dr. Fridinger has nothing to disclose. Dr. Szperka has received research support from Pfizer.