Brousseau David C, Duffy Susan J, Anderson Angela C, Linakis James G
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
Ann Emerg Med. 2004 Feb;43(2):256-62. doi: 10.1016/s0196-0644(03)00716-9.
We compare the effectiveness of intravenous ketorolac and intravenous prochlorperazine in the treatment of pediatric migraine headaches.
We performed a prospective, randomized, double-blind clinical trial in 2 pediatric emergency departments (EDs) within children's hospitals. Children aged 5 to 18 years presenting to the ED with migraine headaches were eligible for the study. Contraindications to either medication or the inability to complete the pain score resulted in exclusion. Children were randomized to receive intravenous ketorolac (0.5 mg/kg; maximum 30 mg) or intravenous prochlorperazine (0.15 mg/kg; maximum 10 mg). All children also received a normal saline solution bolus. Successful treatment was defined as a 50% or greater reduction in the Nine Faces Pain Scale score at 60 minutes. If a less than 50% improvement occurred by 60 minutes, the child received the other medication. Forty-eight-hour follow-up telephone calls were made to each family to assess recurrence and late side effects.
Sixty-two children were enrolled: 33 initially received prochlorperazine, and 29 initially received ketorolac. By 60 minutes, 16 (55.2%) of 29 of those who received ketorolac and 28 (84.8%) of 33 of those who received prochlorperazine were successfully treated (difference=30%; 95% confidence interval [CI] 8% to 52%). Fifty-six (93.3%) of the 60 children who completed the study were successfully treated by the study's conclusion. Approximately 30% of each group had a recurrence of some headache symptoms. Only 2 children reported side effects, both mild and self-limited.
In children, intravenous prochlorperazine is superior to intravenous ketorolac in the acute treatment of migraine headaches.
我们比较静脉注射酮咯酸和静脉注射丙氯拉嗪治疗儿童偏头痛的疗效。
我们在儿童医院的2个儿科急诊科进行了一项前瞻性、随机、双盲临床试验。因偏头痛到急诊科就诊的5至18岁儿童符合研究条件。有任何一种药物的禁忌症或无法完成疼痛评分的儿童被排除。儿童被随机分为接受静脉注射酮咯酸（0.5mg/kg；最大剂量30mg）或静脉注射丙氯拉嗪（0.15mg/kg；最大剂量10mg）。所有儿童还接受了生理盐水推注。成功治疗定义为60分钟时九脸疼痛量表评分降低50%或更多。如果60分钟时改善不足50%，儿童接受另一种药物治疗。对每个家庭进行48小时随访电话，以评估复发情况和晚期副作用。
62名儿童入组：33名最初接受丙氯拉嗪，29名最初接受酮咯酸。到60分钟时，接受酮咯酸的29名儿童中有16名（55.2%）和接受丙氯拉嗪的33名儿童中有28名（84.8%）成功治疗（差异=30%；95%置信区间[CI]8%至52%）。在完成研究的60名儿童中，56名（93.3%）在研究结束时成功治疗。每组约30%的儿童出现了一些头痛症状复发。只有2名儿童报告了副作用，均为轻度且自限性。
在儿童中，静脉注射丙氯拉嗪在偏头痛急性治疗中优于静脉注射酮咯酸。
