Treating primary headaches in the ED: can droperidol regain its role?
OBJECTIVE
The aim of this study was to describe the use and efficacy of low-dose (≤2 mg) droperidol for the treatment of primary headaches (ie, migraine, cluster, tension-type headache and trigeminal autonomic cephalalgias, and other primary headaches) in the emergency department (ED).


METHODS
A report was generated from a pharmacy database to identify all adult patients who received low-dose droperidol in the ED over a 7-month period; a subsequent retrospective chart review was conducted. Low-dose droperidol was defined as a cumulative dose of ≤2 mg. Patients who received droperidol for any other reason than the treatment of a headache were excluded. Data were analyzed descriptively.


RESULTS
Seventy-three cases in which droperidol was administered for the treatment of a headache were identified over the 7-month period. Most doses (92%) administered were 1.25 mg or less. Fifty-three patients (73%) had complete resolution or significant improvement of headache symptoms as subjectively or objectively (eg, numerical pain scale) documented by the treating physician. Eight patients (11%) had minimal improvement in their headaches symptoms; 12 patients (16%) received no relief after the administration of droperidol. The average time to discharge from the ED was 94.8 ± 67.2 minutes. No cardiac arrhythmias were noted. Other adverse events included 2 cases of extrapyramidal side effects; one patient reported restlessness/anxiousness and the other patient had dystonia.


CONCLUSIONS
The administration of low-dose (≤2 mg) droperidol may be safe and effective for the treatment of primary headaches in the ED.
Department of Emergency Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA. brett-faine@uiowa.edu
Brett
B
Faine
Christopher
C
Hogrefe
Jon
J
Van Heukelom
Jamie
J
Smelser
D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001480:Basal Ganglia Diseases / Q000139:chemically induced; D004329:Droperidol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004636:Emergency Service, Hospital; D005260:Female; D006261:Headache / Q000188:drug therapy*; D006801:Humans; D008297:Male; D059408:Pain Management; D010147:Pain Measurement; D012189:Retrospective Studies
D000700:Analgesics; D004329:Droperidol