EMERGENCY DEPARTMENT MANAGEMENT OF MIGRAINE IN CHILDREN: A PRACTICE VARIATION STUDY
Bibliographic record
Abstract
Objectives: Evidence based guidelines for the treatment of children with migraine is limited given the paucity of randomized controlled trials. Our objectives were to: (1) characterize the treatment of children with migraine to identify areas of clinical uncertainty in preparation for future clinical trials; (2) determine the frequency of narcotic use. Methods: Children aged 5 to 17 years presenting to the four regional hospitals in Edmonton, Alberta, Canada during the 2003/2004 fiscal year with a diagnostic code of headache or migraine were selected. A standardized retrospective chart abstraction was performed and migraine or probable migraine cases were classified based on the International Classification of Headache Disorders II. Results: Three hundred and four headache cases were identified of which 58.2% (n=177/304) met sufficient criteria for migraine or probable migraine. Narcotic medications were prescribed in 13.6% of migraine patients while 29.4% received no treatment. Oral simple analgesics (27.7%) and intravenous therapy with a dopamine antagonist, non-steroidal anti-inflammatory (NSAID), or dihydroergotamine (28.2%) were prescribed at similar rates. No predictors were identified. Common therapeutic strategies included: (1) dopamine antagonist (i.e. metoclopramide or prochlorperazine) (35.6%); (2) combination of a dopamine antagonist and NSAID (10.2%; n=18); and (3) oral simple analgesic or NSAID (28.8%; n=51). Dihydroergotamine (6.8%), narcotics alone (6.2%) and steroids (1.7%) were used infrequently in migraine patients. Efficacy could not be determined although 98.4% of patients were discharged home. No significant side-effects were documented. Conclusion: Clinical areas of uncertainty in the treatment of pediatric migraine include: (1) the use of oral therapy vs. intravenous therapy; (2) combination therapy (e.g. dopamine antagonist and NSAID) vs. dopamine antagonists alone; (3) the outcome of children when no therapy is prescribed; and (4) the efficacy of less common therapies including dihydroergotamine, steroids, and possibly narcotics. Future clinical trials are required to help physicians and emergency departments establish pediatric specific evidence-based guidelines in the treatment of migraine.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.021 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".