Intravenous prochlorperazine plus diphenhydramine was found to be superior to IV hydromorphone for the treatment of migraine pain in the emergency department setting, according to a new study published in the journal Neurology.
The double-blind study was conducted at 2 emergency departments (ED) in New York City. Participants were randomized to either hydromorphone 1mg (n=64) or prochlorperazine 10mg plus diphenhydramine 25mg (n=62). Diphenhydramine was administered in order to prevent akathisia, a side effect of IV prochlorperazine.
The primary outcome of sustained headache relief (mild or no headache within 2 hours of drug administration maintained for 48 hours) was achieved by 60% (n=37) of patients in the prochlorperazine group versus 31% (n=20) of patients in the hydromorphone group (difference 28%, 95% CI, 12-45, number needed to treat 4, 95% CI, 2-9).
“Ours is the first randomized study to demonstrate that it is not appropriate to administer the opioid, hydromorphone, as a first line therapy for patients with migraine,” said lead researcher Benjamin Friedman, MD, MS, who is also Professor at Albert Einstein College of Medicine and Vice-Chair for Clinical Investigation in the Department of Emergency Medicine at Montefiore.
The researchers followed up with the study participants at 48 hours, 1 and 3 months after their ED visits and both groups had similar long-term outcomes, including comparable number of headache days and return ED visits. Dr Friedman said, “Our study clearly shows there is no benefit to using the opioid hydromorphone as first-line treatment for most migraine patients in the ED.”
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
This article originally appeared on MPR