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No association between metoclopramide treatment in ED and reduced risk of post-concussion headache

  • Author Footnotes
    1 Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 8L1.
    Natalie Bresee
    Footnotes
    1 Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 8L1.
    Affiliations
    Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada

    University of Ottawa, Ottawa, Ontario, Canada
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  • Author Footnotes
    1 Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 8L1.
    Mary Aglipay
    Footnotes
    1 Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 8L1.
    Affiliations
    Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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  • Author Footnotes
    2 The Montreal Children's Hospital, McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC H4A 3J1.
    Alexander Sasha Dubrovsky
    Footnotes
    2 The Montreal Children's Hospital, McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC H4A 3J1.
    Affiliations
    Montreal Children's Hospital-McGill University Health Centre, Montreal, Quebec, Canada
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  • Author Footnotes
    1 Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 8L1.
    Andrée-Anne Ledoux
    Footnotes
    1 Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 8L1.
    Affiliations
    Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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  • Author Footnotes
    1 Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 8L1.
    Franco Momoli
    Footnotes
    1 Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 8L1.
    Affiliations
    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
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  • Author Footnotes
    3 Hospital Ste. Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1C4.
    Jocelyn Gravel
    Footnotes
    3 Hospital Ste. Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1C4.
    Affiliations
    Department of Pediatrics, Hospital Ste. Justine, University of Montreal, Montreal, Quebec, Canada
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  • Author Footnotes
    4 Heritage Medical Research Building, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1.
    Stephen B. Freedman
    Footnotes
    4 Heritage Medical Research Building, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1.
    Affiliations
    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
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  • Author Footnotes
    5 Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW Calgary, Alberta, Canada, T2N 4N1.
    Karen Barlow
    Footnotes
    5 Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW Calgary, Alberta, Canada, T2N 4N1.
    Affiliations
    Department of Pediatrics and Clinical Neurosciences, Alberta's Children's Hospital, Calgary, Alberta, Canada
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  • Author Footnotes
    6 Women and Children's Health Research Institute, University of Alberta, 4-081 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue NW Edmonton, AB T6G 1C9.
    Lawrence Richer
    Footnotes
    6 Women and Children's Health Research Institute, University of Alberta, 4-081 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue NW Edmonton, AB T6G 1C9.
    Affiliations
    Department of Pediatrics, University of Alberta, Women and Children's Health Research Institute, Edmonton, Alberta, Canada
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  • Author Footnotes
    1 Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 8L1.
    Nicholas J. Barrowman
    Footnotes
    1 Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 8L1.
    Affiliations
    University of Ottawa, Ottawa, Ontario, Canada

    Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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  • Roger Zemek
    Correspondence
    Corresponding author at: Department of Pediatrics and Emergency Medecine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa K1H 8L1, Ontario, Canada.
    Affiliations
    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
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  • forthe Pediatric Emergency Research Canada (PERC) 5P concussion team
  • Author Footnotes
    1 Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 8L1.
    2 The Montreal Children's Hospital, McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC H4A 3J1.
    3 Hospital Ste. Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1C4.
    4 Heritage Medical Research Building, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1.
    5 Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW Calgary, Alberta, Canada, T2N 4N1.
    6 Women and Children's Health Research Institute, University of Alberta, 4-081 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue NW Edmonton, AB T6G 1C9.
Published:April 06, 2018DOI:https://doi.org/10.1016/j.ajem.2018.04.007

      Abstract

      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 8–17 years 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.

      Abbreviations:

      PPCS (persistent post-concussion symptom), ED (emergency department), PCSI (post-concussion symptom inventory), 5P (predicting and preventing post-concussive problems in pediatrics study), RCT (randomized clinical trial), PERC (pediatric emergency research Canada)

      Keywords

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