43 Status Migrainosus in Children: A 3 Year Experience with Prochlorperazine

There is limited evidence suggesting that prochlorperazine is effective and safe in the treatment of status migrainosus in children. Evidence in adults suggests that the prevalence of akathisia is high.

To describe the use of prochlorperazine in the treatment of status migrainosus in children.

From Jan/00 to Dec/02 all patients presenting to a pediatric emergency department (PED) diagnosed with status migrainosus and treated with prochlorperazine were followed prospectively 24 hours after discharge with a standardized telephone questionnaire in order to access the efficacy and side effects of the treatment. Our protocol recommends IV prochlorperazine 0.15 mg/kg (max 10 mg) with IV diphenhydramine 0.5 mg/kg (max 25 mg). The subjective part of an akathisia scale (0 to 9) was used to evaluate this side effect: a score of =2 was considered positive. Parents were asked to rate the pain associated with the migraine on a 0 to 10 scale on presentation to the PED, at discharge, and if a relapse occurred after discharge.

Over a three year period 51 patients (29 female/22 male) aged 12±3 years were treated with prochlorperazine. The pain associated with the migraine on presentation was 8.4±1.3 while at discharge it was 1.5±1.8. Out of 51 patients, 18 (35%) had a relapse 14±12 hours after discharge with reported pain level at 4.3±2.4. Three parents reported their child as having abnormal movements described as shaking or tic: it was quantified in one case as mild and occasional. Six patients were reported as being restless: four mild and occasional, one severe and occasional. Nine patients were reported as being unable to stand or sit still: two as occasional, one as severe and occasional. Five patients were reported as being unable to keep their legs still: one as mild and frequent, one as severe and occasional. On the akathisia scale, 13 patients had a score =1 point. However only six (12%) patients could be said to have had akathisia with a score of 2 in four patients and of 3 and 6 in one patient each.

Prochlorperazine appears to be effective in the treatment of status migrainosus in children. Even with the use of diphenhydramine as prophylaxis, it is associated with some extrapyramidal side effects. The prevalence of akathisia appears to be lower than reported in adults; however more objective and subjective assessment is needed.