Monica Piecyk, MD
July 26, 1996
A 35 year old woman with a history of migraine headaches presents to the ER with a recurrent severe migraine.
Clinical Bottom Lines:
1. IV prochlorperazine significantly reduces headache pain and nausea.
2. Patient satisfaction is significant after treatment with IV prochlorperazine.
3. IV prochlorperazine is effective for the acute treatment of migraine headache.
4. IV prochlorperazine is more effective than IV metoclopramide for the relief of migraine headache.
Prospective, randomized, double-blind, placebo-controlled trial .
70 patients age 18-65 with a recurrent episode of migraine headache, treated with either prochlorperazine 10 mg IV, metoclopramide 10 mg IV, or placebo IV .
|Outcome Measure||Median score 30 minutes after treatment
(10 cm nonhatched visual analog scales)
|Clinical Success||82%||46% (p=0.3)||29% (p=0.3)|
1. Clinical success defined a priori as patient satisfaction AND a decrease of 50% or more in 30 minute pain score compared with initial score or absolute pain score of 2.5 or less.
2. Small study size may account for the absence of a statistically significant difference in clinical success between the metoclopramide and placebo groups (p=.37).
3. 2 (8%) patients in the prochlorperazine group and 2 (8%) patients in the metoclopramide group had dystonic reactions and were excluded from the study and data analysis.
1. Coppola M, Yealy DM, and Leibold RA. Randomized, placebo-controlled evaluation of
prochlorperazine versus metoclopramide for emergency department treatment of migraine
headache. Ann Emerg Med 1995;26:541-6.