Publication related to RSI or an RSI staff member
No association between metoclopramide treatment in ED and reduced risk of post-concussion headache.
OBJECTIVE: There is a lack of definitive pediatric literature on effective pharmacotherapy for persistent post-concussion headache symptoms. This study assessed whether acute metoclopramide treatment in the Emergency Department (ED) was associated with a reduction in persistent headache in children at 1- and 4-weeks post-concussion. METHODS: Children aged 8-17years with acute concussion presenting to 9-Canadian Pediatric EDs were enrolled in a prospective cohort study, from August 2013-June 2015. Primary and secondary outcomes were persistent headache at 1- and 4-week post-injury respectively. Headache persistence was based on the one and four-week headache scores minus recalled pre-injury score using the Post-Concussion Symptom Inventory. The association between metoclopramide and headache persistence at 1- and 4-weeks were examined using unadjusted and adjusted regression and 1:4 propensity score matching model. RESULTS: Baseline assessments were completed in 2095 participants; 65 (3.1%) received metoclopramide within 48-hours of injury. At 1- and 4-weeks, 54% (963/1808) and 26% (456/1780) of participants had persistent headache relative to baseline respectively. In unadjusted analysis, no association between metoclopramide and headache persistence at 1-week was found [treated vs. untreated: 1-week (53% vs. 53%; relative risk (RR)=1.0 (95%CI: 0.8, 1.3); 4-weeks (27.3% vs. 25.6%; RR=1.0 (95% CI: 0.9, 1.2)]. Metoclopramide was not associated with lower headache risk on propensity score matching [treated vs. untreated: 1-week, n=220 (52% vs. 59.4%; RR=0.8 (95%CI: 0.6, 1.2) and 4-weeks, n=225 (27.1% vs. 32.8%; RR=0.9 (95%CI: 0.8, 1.1)]. CONCLUSION: Metoclopramide administration was not associated with a reduction in headache persistence in children seeking ED care due to a concussion. Further research is necessary to determine which pharmacotherapies may be effective for acute and persistent post-concussive headache.
Authors
- Bresee, Natalie, Bresee N, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada. Electronic address: nbresee@cheo.on.ca.
- Aglipay, Mary, Aglipay M, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada. Electronic address: magliplay@cheo.on.ca.
- Dubrovsky, Alexander Sasha, Dubrovsky AS, Montreal Children's Hospital-McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: sasha.dubrovsky@mcgill.ca.
- Ledoux, Andree-Anne, Ledoux AA, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada. Electronic address: aledoux@cheo.on.ca.
- Momoli, Franco, Momoli F, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Electronic address: fmomoli@uottawa.ca.
- Gravel, Jocelyn, Gravel J, Department of Pediatrics, Hospital Ste. Justine, University of Montreal, Montreal, Quebec, Canada.
- Freedman, Stephen B, Freedman SB, Department of Pediatrics, Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada. Electronic address: Stephen.Freedman@albertahealthservices.ca.
- Barlow, Karen, Barlow K, Department of Pediatrics and Clinical Neurosciences, Alberta's Children's Hospital, Calgary, Alberta, Canada. Electronic address: kbarlow@ucalgary.ca.
- Richer, Lawrence, Richer L, Department of Pediatrics, University of Alberta, Women and Children's Health Research Institute, Edmonton, Alberta, Canada. Electronic address: lricher@ualberta.ca.
- Barrowman, Nicholas J, Barrowman NJ, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada. Electronic address: nbarrowman@cheo.on.ca.
- Zemek, Roger, Zemek R, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada. Electronic address: rzemek@cheo.on.ca.
OBJECTIVE: There is a lack of definitive pediatric literature on effective pharmacotherapy for persistent post-concussion headache symptoms. This study assessed whether acute metoclopramide treatment in the Emergency Department (ED) was associated with a reduction in persistent headache in children at 1- and 4-weeks post-concussion. METHODS: Children aged 8-17years with acute concussion presenting to 9-Canadian Pediatric EDs were enrolled in a prospective cohort study, from August 2013-June 2015. Primary and secondary outcomes were persistent headache at 1- and 4-week post-injury respectively. Headache persistence was based on the one and four-week headache scores minus recalled pre-injury score using the Post-Concussion Symptom Inventory. The association between metoclopramide and headache persistence at 1- and 4-weeks were examined using unadjusted and adjusted regression and 1:4 propensity score matching model. RESULTS: Baseline assessments were completed in 2095 participants; 65 (3.1%) received metoclopramide within 48-hours of injury. At 1- and 4-weeks, 54% (963/1808) and 26% (456/1780) of participants had persistent headache relative to baseline respectively. In unadjusted analysis, no association between metoclopramide and headache persistence at 1-week was found [treated vs. untreated: 1-week (53% vs. 53%; relative risk (RR)=1.0 (95%CI: 0.8, 1.3); 4-weeks (27.3% vs. 25.6%; RR=1.0 (95% CI: 0.9, 1.2)]. Metoclopramide was not associated with lower headache risk on propensity score matching [treated vs. untreated: 1-week, n=220 (52% vs. 59.4%; RR=0.8 (95%CI: 0.6, 1.2) and 4-weeks, n=225 (27.1% vs. 32.8%; RR=0.9 (95%CI: 0.8, 1.1)]. CONCLUSION: Metoclopramide administration was not associated with a reduction in headache persistence in children seeking ED care due to a concussion. Further research is necessary to determine which pharmacotherapies may be effective for acute and persistent post-concussive headache.
