Effectiveness of Standard Combination Therapy in Pediatric Migraine

Abstract Objective A combination of parenteral medications (often referred to as Standard Combination Therapy or SCT) is frequently used in the treatment of acute migraine in the pediatric emergency department (PED). The primary aim of this study was to evaluate the 2-hour, 24 hour and 7- day impact of one such regimen on pain in children who present to the PED. SCT for purposes of our study is defined as a bolus of intravenous (IV) saline, and a combination of IV ketorolac, prochlorperazine and diphenhydramine. Design This prospective observational study included 120 children between the ages of 7 years and 18 years who presented to the PED with migraine, whose parents could read and understand the consent form in English, and who were treated with SCT. The primary outcome measure for this study was the change in severity of pain as noted by the child using the Faces Pain Scale-Revised. We analyzed normally distributed continuous variables by Mean and Standard Deviation, whereas non-normally distributed continuous variables are reported by Median and Inter Quartile Range. Results Non-parametric Friedman testing on the entire cohort (n=120) noted that there was a statistically significant change in the FACES pain scale from prior to administration of SCT to the 2 hour, 24 hour and 1 week time point with a reduction in pain score of 87.5%, 100% and 50% respectively at the three time points. Conclusions This study noted moderate relief of pain after administration of SCT which persisted up until the 1- week time point.