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A prospective, randomized trial of intravenous prochlorperazine versus subcutaneous sumatriptan in acute migraine therapy in the emergency department.
Ann Emerg Med 2010; 56(1):1-6AE

Abstract

STUDY OBJECTIVE

Intravenous (IV) prochlorperazine with diphenhydramine is superior to subcutaneous sumatriptan in the treatment of migraine patients presenting to the emergency department (ED).

METHODS

In this randomized, double-blind, placebo-controlled trial, after providing written informed consent, patients presenting to the ED with a chief complaint of migraine received a 500-mL bolus of IV saline solution and either 10 mg prochlorperazine with 12.5 mg diphenhydramine IV plus saline solution placebo subcutaneously or saline solution placebo IV plus 6 mg sumatriptan subcutaneously. Pain intensity was assessed with 100-mm visual analog scales (visual analog scale at baseline and every 20 minutes for 80 minutes). The primary outcome was change in pain intensity from baseline to 80 minutes or time of ED discharge if subjects remained in the ED for fewer than 80 minutes after treatment. Sedation and nausea were assessed every 20 minutes with visual analog scale scales, and subjects were contacted within 72 hours to assess headache recurrence.

RESULTS

Sixty-eight subjects entered the trial, with complete data for 66 subjects. Baseline pain scores were similar for the prochlorperazine/diphenhydramine and sumatriptan groups (76 versus 71 mm). Mean reductions in pain intensity at 80 minutes or time of ED discharge were 73 mm for the prochlorperazine/diphenhydramine group and 50 mm for those receiving sumatriptan (mean difference 23 mm; 95% confidence interval 11 to 36 mm). Sedation, nausea, and headache recurrence rates were similar.

CONCLUSION

IV prochlorperazine with diphenhydramine is superior to subcutaneous sumatriptan in the treatment of migraine.

Authors+Show Affiliations

Department of Emergency Medicine, Naval Medical Center, Portsmouth, VA, USA. mkostic@mcw.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

20045576

Citation

Kostic, Mark A., et al. "A Prospective, Randomized Trial of Intravenous Prochlorperazine Versus Subcutaneous Sumatriptan in Acute Migraine Therapy in the Emergency Department." Annals of Emergency Medicine, vol. 56, no. 1, 2010, pp. 1-6.
Kostic MA, Gutierrez FJ, Rieg TS, et al. A prospective, randomized trial of intravenous prochlorperazine versus subcutaneous sumatriptan in acute migraine therapy in the emergency department. Ann Emerg Med. 2010;56(1):1-6.
Kostic, M. A., Gutierrez, F. J., Rieg, T. S., Moore, T. S., & Gendron, R. T. (2010). A prospective, randomized trial of intravenous prochlorperazine versus subcutaneous sumatriptan in acute migraine therapy in the emergency department. Annals of Emergency Medicine, 56(1), pp. 1-6. doi:10.1016/j.annemergmed.2009.11.020.
Kostic MA, et al. A Prospective, Randomized Trial of Intravenous Prochlorperazine Versus Subcutaneous Sumatriptan in Acute Migraine Therapy in the Emergency Department. Ann Emerg Med. 2010;56(1):1-6. PubMed PMID: 20045576.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A prospective, randomized trial of intravenous prochlorperazine versus subcutaneous sumatriptan in acute migraine therapy in the emergency department. AU - Kostic,Mark A, AU - Gutierrez,Francisco J, AU - Rieg,Thomas S, AU - Moore,Tammy S, AU - Gendron,Richard T, Y1 - 2010/01/04/ PY - 2008/12/22/received PY - 2009/11/04/revised PY - 2009/11/19/accepted PY - 2010/1/5/entrez PY - 2010/1/5/pubmed PY - 2010/8/6/medline SP - 1 EP - 6 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 56 IS - 1 N2 - STUDY OBJECTIVE: Intravenous (IV) prochlorperazine with diphenhydramine is superior to subcutaneous sumatriptan in the treatment of migraine patients presenting to the emergency department (ED). METHODS: In this randomized, double-blind, placebo-controlled trial, after providing written informed consent, patients presenting to the ED with a chief complaint of migraine received a 500-mL bolus of IV saline solution and either 10 mg prochlorperazine with 12.5 mg diphenhydramine IV plus saline solution placebo subcutaneously or saline solution placebo IV plus 6 mg sumatriptan subcutaneously. Pain intensity was assessed with 100-mm visual analog scales (visual analog scale at baseline and every 20 minutes for 80 minutes). The primary outcome was change in pain intensity from baseline to 80 minutes or time of ED discharge if subjects remained in the ED for fewer than 80 minutes after treatment. Sedation and nausea were assessed every 20 minutes with visual analog scale scales, and subjects were contacted within 72 hours to assess headache recurrence. RESULTS: Sixty-eight subjects entered the trial, with complete data for 66 subjects. Baseline pain scores were similar for the prochlorperazine/diphenhydramine and sumatriptan groups (76 versus 71 mm). Mean reductions in pain intensity at 80 minutes or time of ED discharge were 73 mm for the prochlorperazine/diphenhydramine group and 50 mm for those receiving sumatriptan (mean difference 23 mm; 95% confidence interval 11 to 36 mm). Sedation, nausea, and headache recurrence rates were similar. CONCLUSION: IV prochlorperazine with diphenhydramine is superior to subcutaneous sumatriptan in the treatment of migraine. SN - 1097-6760 UR - https://www.unboundmedicine.com/medline/citation/20045576/A_prospective_randomized_trial_of_intravenous_prochlorperazine_versus_subcutaneous_sumatriptan_in_acute_migraine_therapy_in_the_emergency_department_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-0644(09)01794-6 DB - PRIME DP - Unbound Medicine ER -