For Migraine in the ED, Prochlorperazine Is Better Than Sumatriptan

January 13, 2010

NEW YORK (Reuters Health) Jan 12 - For patients in the emergency department (ED) with migraine, IV prochlorperazine with diphenhydramine is more effective than subcutaneous sumatriptan, a small prospective trial suggests.

Both prochlorperazine (Compazine) and sumatriptan (Imitrex) are effective for migraine, Dr. Mark A. Kostic, at the Medical College of Wisconsin, Milwaukee, and co-investigators note. However, little is known about how the two compare, they point out in the Annals of Emergency Medicine for January 4.

Their double-blind, placebo-controlled trial included 66 consecutive ED patients, ages 18 to 50, with "typical" migraine diagnosed on the basis of International Headache Society criteria.

Patients were randomly assigned either to subcutaneous sumatriptan 6 mg (n = 34) or to prochlorperazine 10 mg plus diphenhydramine 12.5 mg (to control akathisia) in 500 mL IV saline (n = 32). Because the trial was blinded, each patient also received a sham treatment along with the assigned therapy.

Patients were asked to assess pain and adverse effects every 20 minutes until 80 minutes or emergency department discharge, whichever came first. At baseline, there were no important differences between the groups, according to the authors.

Prochlorperazine was associated with more rapid and significantly greater reduction in pain intensity on a 100-mm visual analog scale (mean decrease in pain intensity 73 mm vs 50 mm with sumatriptan).

Both groups reported similar degrees of sedation. Prochlorperazine-treated patients had less nausea, but the difference was not statistically significant.

Dr. Kostic's team concludes, "The IV prochlorperazine with diphenhydramine route is not only more efficient and more effective but also less expensive."

Ann Emerg Med 2010.

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