Prochlorperazine Effectively Halts Acute Migraine in Emergency Department

Prochlorperazine has shown efficacy in halting acute migraine attack among adults in the emergency department (ED), according to a study recently published in Headache. This could decrease the need for rescue analgesia, though prochlorperazine use may result in higher risk for adverse events compared with placebo.

This systematic review included 771 participants from 11 randomized clinical trials with 15 comparison arms sourced from Cochrane, Web of Science, Scopus, and Medline. All trials examined the efficacy of prochlorperazine in treating migraine headache. The primary outcome among all studies was the number of participants with reduced or aborted headache within 2 hours of medication administration. Other outcomes included the number of adverse events and participants’ request for rescue analgesia. Odds ratios (ORs) were used to compare dichotomous data, while mean differences were used to compare continuous data.

Prochlorperazine demonstrated superior efficacy in headache relief compared with placebo (5 studies; OR=7.23 [95% CI, 3.82-13.68]; low statistical heterogeneity, χ²=2.92), metoclopramide (3 studies; OR=2.89 [95% CI, 1.42-5.86]; low statistical heterogeneity, χ²=1.83), and other drugs (6 studies; OR=3.7 [95% CI, 2.41-5.67]; P <.001; no statistical heterogeneity). While the likelihood of adverse events was not statistically different between prochlorperazine and other drugs (OR=1.88 [95% CI, 0.99-3.59]; P =.054), it was 5.79 (95% CI, 2.43-13.79) times higher with prochlorperazine compared with placebo (P <.001). The risk for akathisia/dystonia was significantly higher with prochlorperazine (OR=2.55 [95% CI, 1.03-6.31]), while the need for rescue analgesia was significantly lower (16% vs 84%; OR=0.16 [95% CI, 0.09-0.27]).

Limitations to this study include the use of trials with significant heterogeneity among controls and methods, a lack of clear conclusion on prochlorperazine’s efficacy vs several other drugs, and a lack of response from corresponding authors regarding missing data.

The study researchers concluded that “[prochlorperazine] (3-mg oral or 10-mg intravenous or 10-mg intramuscular or 25-mg rectal) could improve acute headache in adult patients with migraine visiting the [ED]. In addition, it could reduce the request for rescue analgesia. However, compared with placebo, it may increase the risk of adverse events. Therefore, despite the significant advances in the production and evaluation of new drugs for the treatment of migraine headaches, the usage of [prochlorperazine] for aborting the acute migraine attacks in the [ED] for adult patients is still highly recommended.”

Reference

Golikhatir I, Cheraghmakani H, Bozorgi F, Jahanian F, Sazgar M, Montazer SH. The efficacy and safety of prochlorperazine in patients with acute migraine: a systematic review and meta-analysis [published online April 16, 2019]. Headache. doi:10.1111/head.13527