Metoclopramide and prochlorperazine are dopamine receptor antagonists used to treat headache, often as part of a “migraine cocktail” in the hospital setting.  Dystonic reactions are a known side effect of these medications. The rates of dystonic reactions have not been well characterized in children. 

Medical record data was extracted for patients at a single tertiary-care pediatric hospital who received metoclopramide or prochlorperazine for treatment of headache in the Emergency Department or inpatient units.  Patients were excluded who had baseline diagnoses of dystonia or who were administered other concurrent dopamine agonists or antagonists. 

Dystonic reactions are very rare events among pediatric patients treated for headache, regardless of whether treatment occurs with metoclopramide or prochlorperazine. However, these reactions are more common with prochlorperazine than metoclopramide.  Providers serving children could consider this information among the risks and benefits of whether to select prochlorperazine versus metoclopramide for treatment of headache.