25 Efficacy of oral metoclopramide for the treatment of migraine in children and youth in the emergency department: A retrospective study
Bibliographic record
Abstract
Abstract Background Intravenous (IV) metoclopramide is commonly used as an acute treatment for migraine in children in the emergency department (ED). However, IV administration can be painful and distressing for children; alternative routes of administration should be considered if proven as effective. Oral metoclopramide has been suggested for the treatment of migraine in children based on limited evidence in adults use and pharmacokinetic similarities. Objectives This study aimed to assess the efficacy of oral metoclopramide for treating migraine in children in the ED. Design/Methods We conducted a retrospective cohort study in a tertiary care paediatric ED from September 2023 to September 2024, including children aged 8-18 years who received IV or oral metoclopramide for a migraine episode. The primary outcome was symptom relief, defined as the absence of rescue IV medication after the first dose of metoclopramide. Secondary outcomes included the ED length of stay, return visits within 7 days, and the difference in pain scores pre/post treatment using the verbal numeric scale. Patient identification was achieved using the computerized provider order entry system. A random sample of 10% of the charts was independently reviewed to assess inter-rater reliability. Results Of the 400 children who received metoclopramide in our ED during the study period, 226 met the inclusion criteria. Baseline demographics were similar between the IV and oral groups. The median age was 14 years old, with 69% female, 40% having a past medical history of migraine, and the median pain score prior to medication administration was 7 for both groups. Oral metoclopramide was administered to 78 (35%) children, of whom 83% (65/78) did not require additional treatment, compared to 79% (116/148) in the IV group. Median time spent in the ED was 314 minutes for the oral group versus 499 minutes for the IV group (difference 185; 95%CI: 25 to 268). Three patients were admitted, all in the IV group. 9 (12%) patients in the oral group returned within 7 days, compared to 14 (9%) in the IV group. The mean pain score following the first dose of medication was 2.6 in the oral group versus 1.9 in the IV group (difference 0.7; 95%CI: 0.2- 1.4). Conclusion This study demonstrated that over 80% of children receiving oral metoclopramide for migraine did not require rescue medication, highlighting its potential as a non-invasive and effective intervention for migraines in the paediatric ED. Additionally, these children had a median emergency department stay shorter. This approach could minimize procedural pain and reduce emergency room stays. As the first study evaluating oral metoclopramide for migraines in children, these findings warrant further investigation through a randomized clinical trial.
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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 | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".