title: A randomized controlled trial of prochlorperazine versus metoclopramide for treatment of acute migraine.
abstract: OBJECTIVE
  We compare prochlorperazine 10 mg intravenously versus metoclopramide 20 mg intravenously for the emergency department (ED) treatment of acute migraine.
  
  
  METHODS
  This was a randomized, double-blind, clinical trial comparing 2 parenteral dopamine antagonists. Both drugs were administered during 15 minutes with 25 mg intravenous diphenhydramine. Pain scores on a numeric rating scale were assessed at baseline, every 30 minutes for 2 hours, and by telephone 24 hours after discharge. The primary endpoint was the between-group difference in change in numeric rating scale from baseline to 1 hour postbaseline. Secondary endpoints included mean differences in change in numeric rating scale at 2 and 24 hours, headache relief, adverse effects, and desire to receive the same treatment for future migraines.
  
  
  RESULTS
  Of 152 patients screened, 97 were eligible and 77 were randomized. The mean change in numeric rating scale scores at 1 hour was 5.5 and 5.2 in subjects receiving prochlorperazine and metoclopramide, respectively (difference=0.3; 95% confidence interval [CI] -1.0 to 1.6). Findings were similar at 2 hours and 24 hours. Forty-six percent (18/39) of prochlorperazine and 32% (12/38) of metoclopramide subjects reported adverse events (difference=15%; 95% CI -6% to 36%). Seventy-seven percent (26/34) of prochlorperazine and 73% (27/37) of metoclopramide subjects wanted to receive the same medication in future ED visits (difference=4%; 95% CI -16% to 24%).
  
  
  CONCLUSIONS
  Either prochlorperazine 10 mg intravenously or metoclopramide 20 mg intravenously, combined with diphenhydramine 25 mg intravenously, is an efficacious treatment for ED patients with acute migraine. Three quarters of subjects in both arms would want the same medication for their next migraine.
authors.affiliation: Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY 10467, USA. befriedm@montefiore.org
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Friedman
authors.forename: David
authors.initials: D
authors.lastname: Esses
authors.forename: Clemencia
authors.initials: C
authors.lastname: Solorzano
authors.forename: Niels
authors.initials: N
authors.lastname: Dua
authors.forename: Peter
authors.initials: P
authors.lastname: Greenwald
authors.forename: Radu
authors.initials: R
authors.lastname: Radulescu
authors.forename: Esther
authors.initials: E
authors.lastname: Chang
authors.forename: Michael
authors.initials: M
authors.lastname: Hochberg
authors.forename: Caron
authors.initials: C
authors.lastname: Campbell
authors.forename: Amish
authors.initials: A
authors.lastname: Aghera
authors.forename: Tyson
authors.initials: T
authors.lastname: Valentin
authors.forename: Joseph
authors.initials: J
authors.lastname: Paternoster
authors.forename: Polly
authors.initials: P
authors.lastname: Bijur
authors.forename: Richard B
authors.initials: RB
authors.lastname: Lipton
authors.forename: E John
authors.initials: EJ
authors.lastname: Gallagher
mesh_terms: D000328:Adult; D004155:Diphenhydramine / Q000008:administration & dosage; D018492:Dopamine Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004338:Drug Combinations; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008787:Metoclopramide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008881:Migraine Disorders / Q000145:classification / Q000188:drug therapy*; D017060:Patient Satisfaction; D011346:Prochlorperazine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D018492:Dopamine Antagonists; D004338:Drug Combinations; D004155:Diphenhydramine; D008787:Metoclopramide; D011346:Prochlorperazine