Standard combination therapy remains effective against migraine in kids

The standard combination therapy (SCT) against paediatric migraine—consisting of a combination of parenteral medications—appears to yield moderate pain relief, which persists up to 1 week after administration, a new study has found.

Researchers conducted a prospective observational study of 120 children (aged 7–18 years; 61.1 percent girls) who presented to the paediatric emergency department (PED) with migraine. For the purposes of the present study, SCT included a bolus of intravenous saline with a combination of ketorolac, prochlorperazine, and diphenhydramine.

The study outcome was change in pain severity, as determined by the child through the use of the Faces Pain Scale-Revised (FPS-R) tool. Measurements were collected in person 2 hours after SCT, and through a phone follow-up after 24 hours and 7 days.

Before SCT, the median FPS-R score was 8, which dropped to 1 by the 2-hour mark (p=0.001). This represented an 87.5-percent drop in median pain severity. Notably, 47 children (39.1 percent) reported that they were completely pain-free at this time point.

After 24 hours, the median FPS-R reached 0, representing a significant 100-percent reduction in pain (p=0.001).

But by day 7, migraine pain had slightly rebound, such that the median FPS-R score was 4. Nevertheless, the 50-percent reduction relative to baseline was still statistically significant (p=0.001). Moreover, 53.3 percent and 40.8 percent of the participants were pain-free at the respective follow-up points.

Restricting analysis to children who had received only a single SCT dose prior to discharge did not change the primary findings.

“Our cohort experienced a measurable degree of pain relief in response to SCT at the measured time points. We noted moderate improvement in objective measures of pain not only immediately after SCT but as late as 1 week, low rates of return to the PED, marked satisfaction in both parents, and patients with respect to this form of treatment and low incidence,” the researchers said.