Implementation of an Intravenous Dihydroergotamine Protocol for Refractory Migraine in Children

Objective Retrospective chart review to assess the effectiveness of an institutional intravenous (IV) dihydroergotamine (DHE) therapy protocol for refractory migraine in the pediatric population. Background Limited high‐quality evidence exists to guide the approach to treatment of refractory migraine with IV DHE, particularly in the pediatric population. This study reviews our institutional experience in implementing an IV DHE protocol in children to identify areas for improvement. We specifically sought to determine whether the outcome differed at follow‐up between children who completed the full course of DHE (8 or 9 doses) as specified in our institutional protocol and those who did not. In addition, given the limited Food and Drug Administration‐approved treatments for chronic migraine (CM) in the pediatric population, re‐evaluating the response rate in this group of patients was of particular interest. Methods A retrospective cohort based on a chart review of 159 consecutive pediatric patients who received IV DHE while inpatient at University of Virginia Children’s Hospital over a 9‐year period (January 2011‐January 2019) was identified. Patients were classified according to the International Classification of Headache Disorders, 3rd edition criteria as having CM, status migrainosus, or, in a small number of patients, Other headache with migrainous features. To investigate any benefit of completing the full course of DHE, patients were categorized as having completed the DHE protocol (“Protocol Complete” 8 or 9 doses) or not completing the protocol (“Protocol Incomplete” 50% relief,