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Prochlorperazine vs. promethazine for headache treatment in the emergency department: a randomized controlled trial.
J Emerg Med 2008; 35(3):247-53JE

Abstract

Headache is a very common medical complaint. Four to six percent of the population will have a debilitating headache in their lifetime; and 1-2% of all Emergency Department (ED) visits involve patients with headaches. Although promethazine is used frequently, it has never been studied as a single-agent treatment in undifferentiated headache. We hypothesized that promethazine would be superior to prochlorperazine in the treatment of headache. We conducted a prospective, double-blinded, randomized, controlled trial on patients presenting to our ED between May and August 2005 with a chief complaint of headache. Each subject was randomized to receive either intravenous promethazine 25 mg or prochlorperazine 10 mg, and graded the intensity of their headache on serial 100-mm visual analog scales (VAS). Patients with dystonic reactions or akathesia were treated with diphenhydramine. Adequate pain relief was defined as an absolute decrease in VAS score of 25 mm. After discharge from the ED, patients were queried regarding the recurrence of headache symptoms, the need for additional pain medications, and the occurrence of any side effects since discharge. Thirty-five patients were enrolled in each group. Both drugs were shown to be effective in treatment of headaches. Prochlorperazine provided a faster rate of pain resolution and less drowsiness when compared to promethazine. Both medications were individually effective as abortive therapy for headache. Prochlorperazine was superior to promethazine in the rate of headache reduction and rate of home drowsiness, with similar rates of akathesia, nausea resolution, patient satisfaction, and headache recurrence within 5 days of discharge.

Authors+Show Affiliations

Department of Emergency Medicine, Naval Hospital, Okinawa, Japan. Jcallan1@aol.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

18534808

Citation

Callan, James E., et al. "Prochlorperazine Vs. Promethazine for Headache Treatment in the Emergency Department: a Randomized Controlled Trial." The Journal of Emergency Medicine, vol. 35, no. 3, 2008, pp. 247-53.
Callan JE, Kostic MA, Bachrach EA, et al. Prochlorperazine vs. promethazine for headache treatment in the emergency department: a randomized controlled trial. J Emerg Med. 2008;35(3):247-53.
Callan, J. E., Kostic, M. A., Bachrach, E. A., & Rieg, T. S. (2008). Prochlorperazine vs. promethazine for headache treatment in the emergency department: a randomized controlled trial. The Journal of Emergency Medicine, 35(3), pp. 247-53. doi:10.1016/j.jemermed.2007.09.047.
Callan JE, et al. Prochlorperazine Vs. Promethazine for Headache Treatment in the Emergency Department: a Randomized Controlled Trial. J Emerg Med. 2008;35(3):247-53. PubMed PMID: 18534808.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prochlorperazine vs. promethazine for headache treatment in the emergency department: a randomized controlled trial. AU - Callan,James E, AU - Kostic,Mark A, AU - Bachrach,Ethan A, AU - Rieg,Thomas S, Y1 - 2008/06/05/ PY - 2007/02/24/received PY - 2007/09/01/revised PY - 2007/09/13/accepted PY - 2008/6/7/pubmed PY - 2009/2/13/medline PY - 2008/6/7/entrez SP - 247 EP - 53 JF - The Journal of emergency medicine JO - J Emerg Med VL - 35 IS - 3 N2 - Headache is a very common medical complaint. Four to six percent of the population will have a debilitating headache in their lifetime; and 1-2% of all Emergency Department (ED) visits involve patients with headaches. Although promethazine is used frequently, it has never been studied as a single-agent treatment in undifferentiated headache. We hypothesized that promethazine would be superior to prochlorperazine in the treatment of headache. We conducted a prospective, double-blinded, randomized, controlled trial on patients presenting to our ED between May and August 2005 with a chief complaint of headache. Each subject was randomized to receive either intravenous promethazine 25 mg or prochlorperazine 10 mg, and graded the intensity of their headache on serial 100-mm visual analog scales (VAS). Patients with dystonic reactions or akathesia were treated with diphenhydramine. Adequate pain relief was defined as an absolute decrease in VAS score of 25 mm. After discharge from the ED, patients were queried regarding the recurrence of headache symptoms, the need for additional pain medications, and the occurrence of any side effects since discharge. Thirty-five patients were enrolled in each group. Both drugs were shown to be effective in treatment of headaches. Prochlorperazine provided a faster rate of pain resolution and less drowsiness when compared to promethazine. Both medications were individually effective as abortive therapy for headache. Prochlorperazine was superior to promethazine in the rate of headache reduction and rate of home drowsiness, with similar rates of akathesia, nausea resolution, patient satisfaction, and headache recurrence within 5 days of discharge. SN - 0736-4679 UR - https://www.unboundmedicine.com/medline/citation/18534808/Prochlorperazine_vs__promethazine_for_headache_treatment_in_the_emergency_department:_a_randomized_controlled_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0736-4679(08)00104-2 DB - PRIME DP - Unbound Medicine ER -