Prochlorperzine Is More Effective for Treating Migraines in the ED Than Commonly Used Drugs

Hydromorphone is commonly used in hospital emergency rooms to treat patients with migraines; however, the drug is less effective than the drug prochlorperazine used with diphenhydramine, according to research.

The study, published in the American Academy of Neurology, included 127 individuals who went to 2 emergency departments in New York due to their migraine. Half of the total study group received hydromorphone and half received prochlorperazine. Over a 48-hour period, the researchers considered how many participants sustained headache relief—defined as having a mild headache or no headache 2 hours following taking the drug and maintaining that level for 48 hours without additional medication.

“People go to US emergency departments 1.2 million times a year with migraine, and the opioid drug hydromorphone is used in 25% of these visits, yet there have been no randomized, high-quality studies on its use for acute migraine,” study author Benjamin W. Friedman, MD, MS, of Albert Einstein College of Medicine, said in a statement.

Following the 48 hours, 37 of 62 people (60%) who received prochlorperazine sustained headache relief, while 20 of the 64 people (31%) who received hydromorphone sustained headache relief. Additionally, 31% of patients who received hydromorphone asked for a second dose during the 48 hours while only 8% of those who received prochlorperazine asked for another dose. Also, 36% of patients who received hydromorphone requested other pain-reliever drugs, compared with 6% of the prochlorperazine group.

“While this study demonstrates the overwhelming superiority of prochlorperazine over hydromorphone for initial treatment of acute migraine, the results do not suggest that treatment with IV opioids leads to long-term addiction,” the authors wrote. “In addition, the results should not be used to avoid the use of opioids for people who have not responded well to anti-dopaminergic drugs.”

The researchers also considered whether the use of an opioid drug led to an addiction through returned visits to the emergency room. However, the study was limited because participants were required to have not used opioids in the previous month and have to history of addiction to opioids. Therefore, the participants may have already been at a decreased risk rate for opioid addiction than the general public.