PAIN MANAGEMENT/ORIGINAL RESEARCH 256 ANNALS OF EMERGENCY MEDICINE 43:2 FEBRUARY 2004 David C. Brousseau, MD, MS Susan J. Duffy, MD, MPH Angela C. Anderson, MD James G. Linakis, PhD, MD From the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI (Brousseau); and the Depart- ment of Pediatrics and Section of Emergency Medicine (Duffy, Anderson, Linakis), Brown University, Providence, RI. 0196-0644/$30.00 Copyright © 2004 by the American College of Emergency Physicians. doi:10.1016/mem.2004.395 T reatment of Pediatric Migraine Headaches: A Randomized, Double-Blind Trial of Prochlorperazine Versus Ketorolac Study objective: We compare the effectiveness of intravenous ketorolac and intra- venous prochlorperazine in the treatment of pediatric migraine headaches. Methods: We performed a prospective, randomized, double-blind clinical trial in 2 pediatric emergency departments (EDs) within children’s hospitals. Children aged 5 to 18 years presenting to the ED with migraine headaches were eligible for the study. Contraindications to either medication or the inability to complete the pain score resulted in exclusion. Children were randomized to receive intravenous ketorolac (0.5 mg/kg; maximum 30 mg) or intravenous prochlorperazine (0.15 mg/kg; maximum 10 mg). All children also received a normal saline solution bolus. Successful treatment was defined as a 50% or greater reduction in the Nine Faces Pain Scale score at 60 minutes. If a less than 50% improvement occurred by 60 minutes, the child received the other medication. Forty-eight-hour follow-up telephone calls were made to each family to assess recurrence and late side effects. Results: Sixty-two children were enrolled: 33 initially received prochlorperazine, and 29 initially received ketorolac. By 60 minutes, 16 (55.2%) of 29 of those who received ketorolac and 28 (84.8%) of 33 of those who received prochlorperazine were suc- cessfully treated (difference=30%; 95% confidence interval [CI] 8% to 52%). Fifty-six (93.3%) of the 60 children who completed the study were successfully treated by the study’s conclusion. Approximately 30% of each group had a recurrence of some headache symptoms. Only 2 children reported side effects, both mild and self-limited. Conclusion: In children, intravenous prochlorperazine is superior to intravenous ketorolac in the acute treatment of migraine headaches. [Ann Emerg Med. 2004;43:256-262.] INTRODUCTION Background Migraine headaches are a common and debilitating condition. An estimated 23% of all households had a patient with migraines in 1999, and almost one third of those with migraines reported having missed at least 1 day of school or work in the prior 3 months as a result of a migraine. 1 Data from the pediatric population show that the prevalence of migraine headaches increases as a child enters adolescence, ranging