Ondansetron for Acute Migraine in the Pediatric Emergency Department
Talai A, Heilbrunn B. Ondansetron for acute migraine in the pediatric emergency department. Pediatr Neurol. 2020;103:52-56.
BACKGROUND: Migraine patients are commonly encountered in the pediatric emergency departments. Much of the research on migraine treatment regimens involves antidopaminergic antiemetics such as prochlorperazine and metoclopramide. Despite a comparably more favorable side effect profile, no migraine treatment research has included ondansetron, a selective type three 5-hydroxytryptamine receptor antagonist. Our primary objective was to determine if treatment regimens including ondansetron were successful in reducing verbal pain scores.
METHODS: We retrospectively reviewed patients with migraine aged seven to 18 years who visited the pediatric emergency departments over a four-year period. Charts were reviewed for initial and discharge pain scores, pediatric emergency department revisits, neurology consultation, and opioid administration. The primary outcome was treatment success, defined as reduction in the verbal pain score of 50% or more. Secondary outcomes included adverse effects, receiving non-evidence-based treatment defined as receiving an opioid, neurology consultation rate, and pediatric emergency department revisit rate within 48 hours.
RESULTS: Ninety-eight encounters were included: 42 received ondansetron, 22 received an antidopaminergic, and 34 received no antiemetic. Thirty-eight patients (90%) in the ondansetron group (95% confidence interval 81 to 99) reached treatment success. Pediatric emergency department revisits, opioid administration, neurology consultation, and treatment success were similar among the ondansetron and antidopaminergic groups.
CONCLUSION: Ondansetron may be a useful medication in the treatment regimen of migraine patients in the pediatric emergency department. Preliminary data suggest that ondansetron is comparable to antidopaminergic agents.