From the Department of Pediatric Emergency Medicine, Nicklaus Children's Hospital.
Department of Medical and Population Health Science Research, Florida International University Herbert Wertheim College of Medicine.
Pediatr Emerg Care. 2024 Aug 1;40(8):e169-e173. doi: 10.1097/PEC.0000000000003202. Epub 2024 May 9.
The objectives are to determine whether diphenhydramine coadministered with prochlorperazine versus prochlorperazine only is associated with a difference in the risk of migraine treatment failure, as measured by the need for additional therapy, hospitalization rates, and 72-hour return rates, and to compare extrapyramidal adverse effects between groups.
Retrospective cohort of patients aged 7 to 18 years treated in the emergency department for migraines using prochlorperazine with or without diphenhydramine between 2013 and 2019. Patients were included if they had International Classification of Diseases, Ninth or Tenth Revision, codes for migraine or unspecified headache and were treated with prochlorperazine as part of their initial migraine therapy. Data collected included demographics, medications administered, pain scores, neuroimaging, disposition, return visits, and documentation of extrapyramidal adverse effects. Multivariable logistic regression was used to estimate the association between diphenhydramine coadministration and each of the outcomes.
A total of 1683 patients were included. Overall, 13% required additional therapy with a 16.7% admission rate and a 72-hour return rate of 5.3%. There was no association between initial treatment with diphenhydramine and the odds of additional therapy (adjusted odds ratio [aOR], 0.74 [95% confidence interval {CI}, 0.53-1.03]), admission rates (aOR, 1.22 [95% CI, 0.89-1.67]), or return visit rates (aOR, 0.91 [95% CI, 0.55-1.51]). Extrapyramidal adverse effects occurred in 2.4% of patients in the prochlorperazine group and 0% in the prochlorperazine with diphenhydramine group.
There was no association between diphenhydramine coadministration and the need for additional therapy, 72-hour return visit rates or admission rates. Extrapyramidal effects did not occur in patients treated with diphenhydramine.
本研究旨在确定与单独使用丙氯拉嗪相比，丙氯拉嗪联合苯海拉明是否会导致偏头痛治疗失败的风险（通过需要额外治疗、住院率和 72 小时内复诊率来衡量）出现差异，并比较两组之间的锥体外系不良反应。
这是一项回顾性队列研究，纳入了 2013 年至 2019 年期间在急诊科接受丙氯拉嗪（联合或不联合苯海拉明）治疗的年龄在 7 至 18 岁的偏头痛患者。入选标准为：国际疾病分类第 9 或 10 版编码为偏头痛或不明原因头痛，且作为初始偏头痛治疗方案的一部分接受丙氯拉嗪治疗。收集的数据包括人口统计学特征、用药情况、疼痛评分、神经影像学检查、处置方式、复诊情况以及锥体外系不良反应的记录。采用多变量逻辑回归估计苯海拉明联合用药与各项结局之间的关联。
共纳入 1683 例患者。总体而言，13%的患者需要额外治疗，16.7%的患者需要住院，72 小时内复诊率为 5.3%。初始治疗中使用苯海拉明与需要额外治疗的可能性（校正比值比 [aOR]，0.74 [95%置信区间 {CI}，0.53-1.03]）、住院率（aOR，1.22 [95% CI，0.89-1.67]）或复诊率（aOR，0.91 [95% CI，0.55-1.51]）均无关联。在丙氯拉嗪组，2.4%的患者出现锥体外系不良反应，而在丙氯拉嗪联合苯海拉明组，这一比例为 0%。
苯海拉明联合用药与需要额外治疗、72 小时内复诊率或住院率之间无关联。接受苯海拉明治疗的患者未出现锥体外系反应。
