A Comparison of Headache Treatment in the Emergency Department: Prochlorperazine Versus Ketamine

Zitek, Tony; Gates, M.; Pitotti, Christopher; Bartlett, Alexandria; Patel, Jayme; Rahbar, Aryan; Forred, W.; Sontgerath, Joseph S.; Clark, Julian

doi:10.1016/j.annemergmed.2017.08.063

Cited by 32 publications

(78 citation statements)

References 26 publications

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“…Several studies have demonstrated either similar or superior reduction in symptoms with various anti‐dopaminergic agents when compared with opioids . The most commonly studied anti‐dopaminergic agents used to treat headaches are prochlorperazine and metoclopramide with substantial evidence supporting their efficacy . These two agents were also the most commonly used anti‐dopaminergic agents in our study.…”

Section: Discussionmentioning

confidence: 99%

“…The main goals in treating the atraumatic headache are ruling out life‐threatening conditions, treating pain, and preventing recurrence . The treatment for atraumatic headaches in the ED varies and includes dopaminergic antagonists, non‐steroidal anti‐inflammatory drugs (NSAIDS), typical antipsychotics, ketamine, and acetaminophen . Despite professional association guidelines recommending against the routine use of opioids for atraumatic headache, opioids made up more than half of all medications given to treat this condition in one multicenter ED study in 2010 …”

Section: Introductionmentioning

confidence: 99%

“…Severe atraumatic headaches often lead patients to seek emergency care. Headaches were the fifth leading cause of emergency department (ED) visits in 2016, accounting for 2.8% of encounters (4.1 million) that varies and includes dopaminergic antagonists, [6][7][8][9][10][11][12][13][14][15][16][17][18] non-steroidal anti-inflammatory drugs (NSAIDS), [19][20][21][22][23] typical antipsychotics, [24][25][26][27][28] ketamine, 18 and acetaminophen. 29 Despite professional association guidelines recommending against the routine use of opioids for atraumatic headache, 4,30,31 opioids made up more than half of all medications given to treat this condition in one multicenter ED study in 2010.…”

Section: Introductionmentioning

confidence: 99%

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Out‐of‐hospital assessment and treatment of adults with atraumatic headache

Jarvis

Johnson

Crowe³

2020

JACEP Open

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Objective Little is known about the presentation or management of patients with headache in the out‐of‐hospital setting. Our primary objective is to describe the out‐of‐hospital assessment and treatment of adults with benign headache. We also describe meaningful pain reduction stratified by commonly administered medications. Methods This retrospective evaluation was conducted using data from a large national cohort. We included all 911 responses by paramedics for patients 18 and older with headache. We excluded patients with trauma, fever, suspected alcohol/drug use, or who received medications suggestive of an alternate condition. We presented our findings with descriptive statistics. Results Of the 5,977,612 emergency responses, 1.1% (66,235) had a provider‐documented primary impression of headache or migraine and 52.5% (34,763) met inclusion criteria. An initial pain score was recorded for 73.5% (25,544) of patients, and 58.5% (14,948) of these patients had multiple pain scores documented. Of the patients with multiple pain scores documented, 53.8% (8037) of patients had an initial pain score >5. Of these, 7.1% (573) were administered any medication. Among patients receiving a single medication, Fentanyl was the most commonly administered (32.1%, 126). As a group, opioids were the most commonly administered class of drugs (38.9%, 153) and were associated with the largest proportion of clinically significant pain reduction (69.3%, 106). Dopamine antagonists were given least frequently (9.9%, 39) but had the second largest proportion of pain reduction (43.6%, 17). Conclusion Out‐of‐hospital pain scores were documented infrequently and less than one in five patients with initial pain scores >5 received medication. Additionally, adherence to evidence‐based guidelines was infrequent.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Out‐of‐hospital assessment and treatment of adults with atraumatic headache

Jarvis

Johnson

Crowe³

2020

JACEP Open

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“…Furthermore, due to the inconsistent reporting of the data related to the main outcomes across the included studies, we were not able to combine completely the results of all studies. Moreover, we excluded some studies because they did not separate migraine headaches from other headaches and/or provided no separate data for participants with migraines …”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have recommended intravenous prochlorperazine (PCP) for the acute treatment of migraine; however, their recommendations were based on the limited number of randomized clinical trials and observational studies. Recently, several trials have examined the efficacy of PCP on aborting migraine attacks or reducing the severity of migraine headache in the ED and found controversial results along with some serious adverse events such as extrapyramidal symptoms . Regarding the efficacy and safety of PCP for management of adult patients with migraine, a current systematic review and meta‐analysis of the available treatments is needed.…”

Section: Introductionmentioning

confidence: 99%

The Efficacy and Safety of Prochlorperazine in Patients With Acute Migraine: A Systematic Review and Meta‐Analysis

et al. 2019

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Objective The aim of this review was to evaluate the efficacy and safety of prochlorperazine (PCP) in patients with acute migraine headache in the emergency department (ED). Methods Electronic databases (Medline, Scopus, Web of Science, and Cochrane) were searched for randomized clinical trials that investigated the effect of PCP on headache relief. The outcomes were the number of patients without headache or with reduced headache severity, the number of adverse events, and the need for rescue analgesia. Results From 450 citations, 11 studies (n = 771) with 15 comparison arms met the inclusion criteria. Overall, PCP was more effective than placebo (OR = 7.23; 95% CI = 3.82‐3.68), metoclopramide (OR = 2.89; 95% CI = 1.42‐5.86), and other active comparators (OR = 3.70; 95% CI = 2.41‐5.67) for headache relief. The odds ratio of experiencing adverse events with PCP compared with placebo was 5.79 (95% CI = 2.43‐13.79). When PCP compared with other active comparators, no statistical difference was found regarding the overall number of adverse events (OR = 1.88; 95% CI = 0.99‐3.59). However, PCP significantly increased the odds of akathisia/dystonia (OR = 2.55; 95% CI = 1.03‐6.31). The request for rescue analgesia was significantly lower in the PCP group compared with other groups (16% vs 84%; OR = 0.16; 95% CI = 0.09‐27). Conclusions For adult patients with acute migraine, PCP could effectively abort the acute attack and reduce the request for rescue analgesia in the ED. However, compared with placebo, PCP could increase the risk of adverse events.

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Recent advances in biopolymer based electrospun nanomaterials for drug delivery systems

Tören,

Buzgo,

Mazari

et al. 2024

Polymers for Advanced Techs

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Drug delivery systems, including liposomes, gels, prodrugs, and so forth, are used to enhance the tissue benefit of a pharmaceutical drug or conventional substance at a specific diseased site with little toxicological impact. Nanotechnology can be a rapidly developing multidisciplinary science that enables the production of polymers at the manometer scale for different medical applications. The use of biopolymers in drug delivery systems provides compatibility, biodegradability and low immunogenicity biologically. Large‐scale and smaller‐than‐expected medication particles can be delivered using biopolymers such as silk fibroins, collagen, gelatine, and others that are easily formed into suspensions. These drug carrier systems are functional at improving drug delivery and can be used in intranasal, transdermal, dental, and ocular delivery systems. This study discusses the latest developments in drug delivery methods based on nanomaterials, mainly using biopolymers like proteins and polysaccharides.

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A Comparison of Headache Treatment in the Emergency Department: Prochlorperazine Versus Ketamine

Cited by 32 publications

References 26 publications

Out‐of‐hospital assessment and treatment of adults with atraumatic headache

Out‐of‐hospital assessment and treatment of adults with atraumatic headache

The Efficacy and Safety of Prochlorperazine in Patients With Acute Migraine: A Systematic Review and Meta‐Analysis

Recent advances in biopolymer based electrospun nanomaterials for drug delivery systems

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