Assess the utilization of “migraine cocktail” in acute headache management at a tertiary level emergency department (ED)

Migraine headache is a frequent ED admission. Patients receive “migraine cocktail”, a combination therapy that varies with institutions. Common constituents include Dopamine antagonist, NSAID and antihistamine. There is insufficient evidence about the headache relief and the reduced ED stay by using the combination of drugs.

We did retrospective chart review of patients seeking acute headache treatment in ED from July 2017- 2019. Inclusion criteria was acute primary headache patients from age 5-18 years. Patients with secondary causes of headache were excluded. Primary outcome was reduction in headache pain score within 4 hours of treatment. Secondary outcome measures included length of ED stay, hospital admission rate, and ED readmission within 48 hours.

Study yielded 247 patients, among which 47 met inclusion criteria. Out of 47 patients, 60% had a diagnosis of migraine. Mean age was 12.7 years (SD 3), and 70% were female. Mean ED length of stay was 4.6 hours (SD 1.97, p<0.05). Nineteen percent of patients were hospitalized. Most commonly used combination treatment was Benadryl, Metoclopramide and Ketorolac (23%). Metoclopramide was substituted with Prochlorperazine based on physician preference. Fluid bolus was given to 74% of patients, among which 77% were discharged home from ED. Mean pre-treatment pain score was 7.6 (SD 1.6) and post-treatment pain score was 3 (SD 2.4). Mean difference between the two scores was 4.5 (CI, 3.9-5.2), p<0.05. Pain score improvement is associated with ED discharge (Odds ratio 0.25). Age, gender, type of cocktail class, headache duration before ED visit did not affect the discharge from ED

Two third patients were discharged with diagnosis of migraine. Migraine cocktail helped in reducing pain score and hospital admission rates.