IV Prochlorperazine Beats Hydromorphone for Acute Migraine Treatment

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The primary outcome of sustained headache relief was achieved by 60% of 62 participants in the prochlorperazine arm.
The primary outcome of sustained headache relief was achieved by 60% of 62 participants in the prochlorperazine arm.

HealthDay News — Intravenous (IV) hydromorphone is less effective than IV prochlorperazine plus diphenhydramine for acute migraine treatment in the emergency department, according to a study published in Neurology.

Benjamin W. Friedman, MD, from Albert Einstein College of Medicine in Bronx, New York, and colleagues conducted a study involving patients who met international criteria for migraine in 2 emergency departments in New York City. Participants were randomized in blocks of 4 and received hydromorphone 1 mg or prochlorperazine 10 mg plus diphenhydramine 25 mg; diphenhydramine was administered to prevent akathisia, which is a frequent adverse effect of IV prochlorperazine.

After enrollment of 127 patients, the trial was halted by the data monitoring committee. The researchers found that the primary outcome of sustained headache relief was achieved by 60% of 62 participants in the prochlorperazine arm and by 31% of 64 participants in the hydromorphone arm (difference, 28%; number needed to treat, 4).

"IV hydromorphone is substantially less effective than IV prochlorperazine for the treatment of acute migraine in the ED and should not be used as first-line therapy," the authors wrote.

Reference

Friedman BW, Irizarry E, Solorzano C, et al. Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine [published online October 18, 2017]. Neurology. doi:10.1212/WNL.0000000000004642

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