Auricular Acupuncture vs SOC in Migraine HA

Study Overview
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Brief Summary
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Patients with migraine headache will be offered the opportunity to participate in this randomized study evaluating auricular acupuncture versus standard treatment for migraine headaches for patients in the pediatric emergency department (ED).

Detailed Description
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Potential subjects will be identified using the diagnosis of migraine headache classified by the modified ICHD-II (International Classification for Headache Disorders) criteria proposed by Hershey et. al. This diagnosis will be confirmed by the investigators prior to enrollment of the subject and will be documented in the study documents. Subjects will be recruited during the scheduled work or research hours of the investigators in the ED. Eligible patients will be informed of the study including a discussion of the two possible interventions. After informed consent and assent are obtained, patients will be randomly assigned 1 of the 2 arms of the study. The target is 40 subjects in each arm. Subjects will be assigned to a study group using a computer generated randomization schema. This randomization will only be known to one unblinded collaborator that will not be enrolling subjects or be involved in the data analysis. If assigned to receive intravenous migraine medications the subject will be treated with the standard of care medications which include ketorolac (0.5mg/kg, max 30mg), metoclopramide (0.1 mg/kg, max 10mg), diphenhydramine (1mg/kg, max 50mg) plus a normal saline fluid bolus (20mL/kg, max 1000mL). If assigned to the auricular acupuncture arm, efficacious ear points will be located by a needle contact test and/or an electrical point finder which emits an acoustic alarm when a change in electrical resistance is detected signifying a potential active auricular acupoint. If the subject does not improve with acupuncture, they will be assessed by the ED physician and at the MD discretion further emergency department treatment will be administered which may include intravenous migraine medications as this is the current standard of care in the Norton Children's Hospital/Norton Children's Medical Center (KCH/KCMC) ED. All subjects will be contacted 2 to 6 days after discharge to determine their clinical status. If the darts are still in place at the follow-up call, the subjects will be contacted at 2 weeks and weekly thereafter until all darts have fallen out.

Official Title
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A Randomized Trial Comparing Auricular Acupuncture and Intravenous Migraine Medications in the Treatment of Status Migrainosus in the Pediatric Emergency Department

Conditions
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Migraine Headache

Intervention / Treatment
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* Other: Auricular Acupuncture
* Drug: Ketorolac 0.5mg/kg, max 30mg
* Drug: Metoclopramide 0.1 mg/kg, max 10mg
* Drug: Diphenhydramine 1mg/kg, max 50mg
* Drug: Normal saline fluid bolus 20mL/kg, max 1000mL


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Confirmation of the diagnosis of migraine headache Exclusion Criteria: Patients who received ED migraine medications (including ibuprofen or other NSAIDS) prior to study evaluation. Allergy to any of the medications used in our migraine regimen protocol. Patients exhibiting focal clinical neurological exam findings that the investigator deems makes the patient not a good candidate for this study. Patients with underlying abnormal brain pathology (e.g. mass or bleed) as the potential cause of the migraine

Ages Eligible for Study
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Minimum Age: 8 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Auricular Acupuncture<br>If assigned to the auricular acupuncture arm, efficacious ear points will be located by a needle contact test and/or an electrical point finder which emits an acoustic alarm when a change in electrical resistance is detected signifying a potential active auricular acupoint. | Other: Auricular Acupuncture<br>* ASP (acupuncture semi-permanent) gold needles will be placed in the efficacious ear points with a maximum of 3 needles in each ear.<br>|
| Active Comparator: Medication and Fluid<br>If assigned to receive intravenous medications and fluid the subject will be treated with the ED standard of care medications which include: Ketorolac 0.5mg/kg, max 30mg Metoclopramide 0.1 mg/kg, max 10mg Diphenhydramine 1mg/kg, max 50mg Normal saline fluid bolus 20mL/kg, max 1000mL | Drug: Ketorolac 0.5mg/kg, max 30mg<br>* If assigned to receive intravenous medications and fluid the subject will be treated with the ED standard of care medications which include: Ketorolac 0.5mg/kg, max 30mg Metoclopramide 0.1 mg/kg, max 10mg Diphenhydramine 1mg/kg, max 50mg Normal saline fluid bolus 20mL/kg, max 1000mL<br>* Other names: Toradol;Drug: Metoclopramide 0.1 mg/kg, max 10mg<br>* If assigned to receive intravenous medications and fluid the subject will be treated with the ED standard of care medications which include: Ketorolac 0.5mg/kg, max 30mg Metoclopramide 0.1 mg/kg, max 10mg Diphenhydramine 1mg/kg, max 50mg Normal saline fluid bolus 20mL/kg, max 1000mL<br>* Other names: Reglan;Drug: Diphenhydramine 1mg/kg, max 50mg<br>* If assigned to receive intravenous medications and fluid the subject will be treated with the ED standard of care medications which include: Ketorolac 0.5mg/kg, max 30mg Metoclopramide 0.1 mg/kg, max 10mg Diphenhydramine 1mg/kg, max 50mg Normal saline fluid bolus 20mL/kg, max 1000mL<br>* Other names: Benadryl;Drug: Normal saline fluid bolus 20mL/kg, max 1000mL<br>* If assigned to receive intravenous medications and fluid the subject will be treated with the ED standard of care medications which include: Ketorolac 0.5mg/kg, max 30mg Metoclopramide 0.1 mg/kg, max 10mg Diphenhydramine 1mg/kg, max 50mg Normal saline fluid bolus 20mL/kg, max 1000mL<br>* Other names: Normal Saline;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in baseline pain score by a numerical self-reported visual analog pain score (VAS) | Pre-and post-intervention pain scores (0 to 10) by a numerical self-reported visual analog pain score (VAS) | Baseline and 15 minutes after completion of intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of pain relief using the VAS pain scale | Data to be collected on this phone follow-up include return of migraine/headache using the VAS pain scale; return to ED or PMD for migraine/headache symptoms; and medications taken for headache since discharge from the ED. | 2 to 6 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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migraine headache, acupuncture