Intravenous Chlorpromazine vs Intravenous Metoclopramide in Acute Migraine Headache

Abstract

Objective:To compare the efficacy of IV chlorpromazine with that of IV metoclopramide in the treatment for acute migraine headache in the ED. Methods:A prospective randomized double-blind trial was undertaken at two university-affiliated urban EDs with a combined annual census of more than 85,000 patients. Included in the study were patients presenting to the E D with a diagnosis of migraine headache. The subjects were randomized to receive 0.1 mg/kg/dose IV of either chlorpromazine (CPZ) or metoclopramide (MC), up to a total of three doses.Results: Ninety-one patients completed the protocol; 44 received MC and 47 received CPZ. The demographics of the two groups were similar. Both drugs provided, for the majority of patients, adequate pain relief as measured on a visual analog scale (VAS) completed every 15 minutes from T = 0 minutes t o T = 45 minutes. The average pain relief over 45 minutes (AVAS) for CPZ was 4.87 cm, vs 4.34 cm for MC (p = 0.35). There also was no statistically significant difference in blood pressure (BP) changes (ABP < 2 mm Hg for both systolic and diastolic BPs, p = 0.47 and 0.33) or numbers of patients reporting adverse effects (AEs) (CPZ: 16 of 35; MC: 13 of 29, p = 0.43). There was no severe A € with either study drug. Conclusions:Metoclopramide and chlorpromazine administered 1V are both effective in the management of acute migraine headache. They are associated with similar minor side-effect profiles.

Dexamethasone prevents relapse after emergency department treatment of acute migraine: a randomized clinical trial

“…Emergency physicians tend to define headache treatment as successful if the patient leaves the ED feeling better than he or she did on arrival; however, several studies 8,11,15,19,[22][23][24][25][26] have shown that migraine victims often suffer recurrent headaches after discharge. Reported recurrence rates are 8.1% for methotrimeprazine, 11 34% to 53% for sumatriptan, 19,[22][23][24] 11% to 66% for chlorpromazine, 8,25 13% to 47% for dihydroergotamine, 8,15 24% to 56% for meperidine 11,26 and 87% for intramuscular ketorolac.…”

“…21 Although the acute headache can generally be relieved, 8% to 66% of patients will suffer a recurrence within 48 hours. 8,11,15,19,[22][23][24][25][26] Many physicians believe that extracranial vasodilatation is integral to migraine genesis, yet it is clear that these headaches are not simply vascular phenomena, and existing data support the hypothesis that inflammation is a critical mechanism.…”

“…Reported recurrence rates are 8.1% for methotrimeprazine, 11 34% to 53% for sumatriptan, 19,[22][23][24] 11% to 66% for chlorpromazine, 8,25 13% to 47% for dihydroergotamine, 8,15 24% to 56% for meperidine 11,26 and 87% for intramuscular ketorolac. 26 This suggests that as emergency physicians we need to re-evaluate our management of acute headaches and our definition of therapeutic success.…”

Intravenous dexamethasone to prevent the recurrence of benign headache after discharge from the emergency department: a randomized, double-blind, placebo-controlled clinical trial

“…Traditionally, acute symptomatic relief in the ED was believed to be the final end point; however, medications currently used for ED headache management may not provide sustained relief after patient discharge. Reported rates of post-treatment relapse include 34%-53% for sumatriptan, [10][11][12] 11%-66% for chlorpromazine, 13,26 24%-56% for meperidine 27,28 and 87% for intramuscular (IM) ketorolac. 28 The pathogenesis of acute benign headache (and headache recurrence) remains controversial, but previous studies support the hypothesis that neurogenic inflammation plays a central role.…”

Tratamento agudo da crise de enxaqueca refratária na emergência: estudo comparativo entre dexametasona e haloperidol. Resultados preliminares

“…A utilização de neurolépticos, no tratamento agudo e emergencial da crise de enxaqueca, vem mostrando resultados animadores. Sua eficácia é comprovada tanto em estudos que os utilizaram isoladamente, como em ensaios clínicos que os compararam com outras drogas como: triptanos, AINEs IV, 514 Arq Neuropsiquiatr 2004;62 (2-B) anticonvulsivantes injetáveis (valproato de sódio), sulfato de magnésio IV e antieméticos IV [10][11][12][13][14][15] . Constituem um grupo de medicamentos classe II de evidência 6 , já que poucos são os estudos prospectivos, randomizados e duplo-cegos; além de se questionar por qual(ais) via (s) de receptores eles exerceriam sua função analgésica 16 .…”