Ondansetron is effective for acute migraine

Treatment regimens that include ondansetron as the antiemetic of choice for children who visit a pediatric emergency department (PED) for acute migraine are safe and effective, according to a retrospective review.

Investigators examined the charts of 98 children ranging in age from 7 to 18 years who visited a PED in Chicago over a 4-year period and were given a discharge diagnosis of migraine. Forty-two children received ondansetron (a selective type 3 5-hydroxytryptamine receptor antagonist); 22 an antidopaminergic; and 34 no antiemetic. Patients also were given a combination of other medications, including intravenous fluids, acetaminophen, nonsteroidal anti-inflammatory drugs, diphenhydramine, or opioids. Nurses administered a 10-point numeric verbal pain score (VPS) test (0 indicating no pain and 10 the worst possible pain) during triage and again before discharge.

Investigators defined treatment success as a reduction in the VPS of 50% or more, which was achieved by 38 patients (90%) in the ondansetron group, 91% of those receiving an antidopaminergic, and 94% of those given no antiemetic. No one in the ondansetron group reported adverse effects. The 3 groups did not differ significantly as to their rate of neurology consultation, revisits to the PED, or opioid use (Talai A, et al. Pediatr Neurol. 2020;103:52-56).

Thoughts from Dr. Farber

Ondansetron is one of my favorite medicines. It has prevented numerous children from being hospitalized for vomiting. Here is yet another use for it. The authors echo my experience, that adverse effects from using it are rare.