IV Prochlorperazine Beats IV Hydromorphone for Migraine
IV hydromorphone much less effective for migraine treatment in the emergency department
THURSDAY, Oct. 19, 2017 (HealthDay News) -- Intravenous (IV) hydromorphone is less effective than IV prochlorperazine plus diphenhydramine for acute migraine treatment in the emergency department, according to a study published online Oct. 18 in Neurology.
Benjamin W. Friedman, M.D., from Albert Einstein College of Medicine in Bronx, New York, and colleagues conducted a study involving patients who met international criteria for migraine in two emergency departments in New York City. Participants were randomized in blocks of four and received hydromorphone 1 mg or prochlorperazine 10 mg plus diphenhydramine 25 mg; diphenhydramine was administered to prevent akathisia, which is a frequent adverse effect of IV prochlorperazine.
After enrollment of 127 patients, the trial was halted by the data monitoring committee. The researchers found that the primary outcome of sustained headache relief was achieved by 60 percent of 62 participants in the prochlorperazine arm and by 31 percent of 64 participants in the hydromorphone arm (difference, 28 percent; number needed to treat, 4).
"IV hydromorphone is substantially less effective than IV prochlorperazine for the treatment of acute migraine in the ED and should not be used as first-line therapy," the authors write.