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A randomized controlled trial of prochlorperazine versus metoclopramide for treatment of acute migraine.
Ann Emerg Med. 2008 Oct; 52(4):399-406.AE

Abstract

STUDY OBJECTIVE

We compare prochlorperazine 10 mg intravenously versus metoclopramide 20 mg intravenously for the emergency department (ED) treatment of acute migraine.

METHODS

This was a randomized, double-blind, clinical trial comparing 2 parenteral dopamine antagonists. Both drugs were administered during 15 minutes with 25 mg intravenous diphenhydramine. Pain scores on a numeric rating scale were assessed at baseline, every 30 minutes for 2 hours, and by telephone 24 hours after discharge. The primary endpoint was the between-group difference in change in numeric rating scale from baseline to 1 hour postbaseline. Secondary endpoints included mean differences in change in numeric rating scale at 2 and 24 hours, headache relief, adverse effects, and desire to receive the same treatment for future migraines.

RESULTS

Of 152 patients screened, 97 were eligible and 77 were randomized. The mean change in numeric rating scale scores at 1 hour was 5.5 and 5.2 in subjects receiving prochlorperazine and metoclopramide, respectively (difference=0.3; 95% confidence interval [CI] -1.0 to 1.6). Findings were similar at 2 hours and 24 hours. Forty-six percent (18/39) of prochlorperazine and 32% (12/38) of metoclopramide subjects reported adverse events (difference=15%; 95% CI -6% to 36%). Seventy-seven percent (26/34) of prochlorperazine and 73% (27/37) of metoclopramide subjects wanted to receive the same medication in future ED visits (difference=4%; 95% CI -16% to 24%).

CONCLUSION

Either prochlorperazine 10 mg intravenously or metoclopramide 20 mg intravenously, combined with diphenhydramine 25 mg intravenously, is an efficacious treatment for ED patients with acute migraine. Three quarters of subjects in both arms would want the same medication for their next migraine.

Authors+Show Affiliations

Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY 10467, USA. befriedm@montefiore.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

18006188

Citation

Friedman, Benjamin W., et al. "A Randomized Controlled Trial of Prochlorperazine Versus Metoclopramide for Treatment of Acute Migraine." Annals of Emergency Medicine, vol. 52, no. 4, 2008, pp. 399-406.
Friedman BW, Esses D, Solorzano C, et al. A randomized controlled trial of prochlorperazine versus metoclopramide for treatment of acute migraine. Ann Emerg Med. 2008;52(4):399-406.
Friedman, B. W., Esses, D., Solorzano, C., Dua, N., Greenwald, P., Radulescu, R., Chang, E., Hochberg, M., Campbell, C., Aghera, A., Valentin, T., Paternoster, J., Bijur, P., Lipton, R. B., & Gallagher, E. J. (2008). A randomized controlled trial of prochlorperazine versus metoclopramide for treatment of acute migraine. Annals of Emergency Medicine, 52(4), 399-406.
Friedman BW, et al. A Randomized Controlled Trial of Prochlorperazine Versus Metoclopramide for Treatment of Acute Migraine. Ann Emerg Med. 2008;52(4):399-406. PubMed PMID: 18006188.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomized controlled trial of prochlorperazine versus metoclopramide for treatment of acute migraine. AU - Friedman,Benjamin W, AU - Esses,David, AU - Solorzano,Clemencia, AU - Dua,Niels, AU - Greenwald,Peter, AU - Radulescu,Radu, AU - Chang,Esther, AU - Hochberg,Michael, AU - Campbell,Caron, AU - Aghera,Amish, AU - Valentin,Tyson, AU - Paternoster,Joseph, AU - Bijur,Polly, AU - Lipton,Richard B, AU - Gallagher,E John, Y1 - 2007/11/19/ PY - 2007/06/28/received PY - 2007/08/28/revised PY - 2007/09/21/accepted PY - 2007/11/17/pubmed PY - 2008/10/8/medline PY - 2007/11/17/entrez SP - 399 EP - 406 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 52 IS - 4 N2 - STUDY OBJECTIVE: We compare prochlorperazine 10 mg intravenously versus metoclopramide 20 mg intravenously for the emergency department (ED) treatment of acute migraine. METHODS: This was a randomized, double-blind, clinical trial comparing 2 parenteral dopamine antagonists. Both drugs were administered during 15 minutes with 25 mg intravenous diphenhydramine. Pain scores on a numeric rating scale were assessed at baseline, every 30 minutes for 2 hours, and by telephone 24 hours after discharge. The primary endpoint was the between-group difference in change in numeric rating scale from baseline to 1 hour postbaseline. Secondary endpoints included mean differences in change in numeric rating scale at 2 and 24 hours, headache relief, adverse effects, and desire to receive the same treatment for future migraines. RESULTS: Of 152 patients screened, 97 were eligible and 77 were randomized. The mean change in numeric rating scale scores at 1 hour was 5.5 and 5.2 in subjects receiving prochlorperazine and metoclopramide, respectively (difference=0.3; 95% confidence interval [CI] -1.0 to 1.6). Findings were similar at 2 hours and 24 hours. Forty-six percent (18/39) of prochlorperazine and 32% (12/38) of metoclopramide subjects reported adverse events (difference=15%; 95% CI -6% to 36%). Seventy-seven percent (26/34) of prochlorperazine and 73% (27/37) of metoclopramide subjects wanted to receive the same medication in future ED visits (difference=4%; 95% CI -16% to 24%). CONCLUSION: Either prochlorperazine 10 mg intravenously or metoclopramide 20 mg intravenously, combined with diphenhydramine 25 mg intravenously, is an efficacious treatment for ED patients with acute migraine. Three quarters of subjects in both arms would want the same medication for their next migraine. SN - 1097-6760 UR - https://www.unboundmedicine.com/medline/citation/18006188/A_randomized_controlled_trial_of_prochlorperazine_versus_metoclopramide_for_treatment_of_acute_migraine_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-0644(07)01557-0 DB - PRIME DP - Unbound Medicine ER -