Oral Metoclopramide for Pediatric Migraine in the ED: Health Records Review
Authors: Rouge Elton P-A, Lucas N, Trottier ED, Mousseau S, Tourigny-Ruel G, Métras M-E, Gravel J
Journal: CJEM, April 2026
Conclusions:
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Oral metoclopramide worked for most kids: ~83% of pediatric migraine patients treated PO did not need rescue meds.
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In exploratory comparisons, PO looked similar to IV for headache relief, with shorter ED LOS and fewer adverse events (none in PO group).
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Practical takeaway: if the child can tolerate PO and isn’t vomiting/dehydrated/needs IV meds for other reasons, PO metoclopramide is a legit first-line option and may help flow (and avoids the needle battle).
Practice pearls:
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Start PO when you can: stable kid, tolerating PO, no red flags, no need for IV access → PO metoclopramide can spare IV placement and may shorten throughput.
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IV still has a role: persistent vomiting, dehydration, failed PO, severe pain requiring IV cocktail, or concern for alternative diagnoses.
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If you’re using metoclopramide, consider your usual akathisia/dystonia mitigation strategy—this paper’s AE signal was small but only appeared in the IV group.
Results:
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Setting: Tertiary pediatric ED, Montréal; 1-year retrospective cohort.
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N=225 migraine patients age 8–18 treated with metoclopramide:
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Oral: 78
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IV: 147
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Primary outcome (no rescue medication = “headache relief”):
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Oral: 83% (95% CI 73–91%).
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Exploratory vs IV: difference 4% (95% CI −7 to 14%) → no clear advantage to IV.
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ED length of stay:
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Oral median 314 min vs IV 500 min (not trivial).
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Adverse events:
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Only in IV group: 4% (none in oral).
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7-day returns:
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Similar between groups (difference 2%, 95% CI −6 to 12%).
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Pain score reduction measured, but headline finding is “most PO patients didn’t need rescue.”
Methods:
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Retrospective cohort of 8–18-year-olds diagnosed with migraine and treated with oral or IV metoclopramide.
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Primary analysis focused on proportion of oral-treated children not requiring rescue meds; secondary exploratory analyses compared PO vs IV.
Rouge Elton, P.A., Lucas, N., D. Trottier, E., Mousseau, S., Tourigny-Ruel, G., Métras, M.E. and Gravel, J., 2026. Oral metoclopramide for pediatric migraine management in the ED: health records review. Canadian Journal of Emergency Medicine, pp.1-10.