A randomized study of IV prochlorperazine plus diphenhydramine versus IV hydromorphone for migraine-associated symptoms: A post hoc analysis.
Administration, Intravenous
Adult
Analgesics, Opioid
/ administration & dosage
Antiemetics
/ administration & dosage
Diphenhydramine
/ administration & dosage
Double-Blind Method
Drug Therapy, Combination
Female
Humans
Hydromorphone
/ administration & dosage
Hyperacusis
/ drug therapy
Male
Middle Aged
Migraine Disorders
/ complications
Nausea
/ drug therapy
Outcome Assessment, Health Care
Photophobia
/ drug therapy
Prochlorperazine
/ administration & dosage
hydromorphone
migraine
opioid
prochlorperazine
relief
sustained
Journal
Headache
ISSN: 1526-4610
Titre abrégé: Headache
Pays: United States
ID NLM: 2985091R
Informations de publication
Date de publication:
09 2021
09 2021
Historique:
revised:
18
05
2021
received:
27
02
2021
accepted:
24
05
2021
pubmed:
8
8
2021
medline:
15
2
2022
entrez:
7
8
2021
Statut:
ppublish
Résumé
We conducted a randomized trial among emergency department patients with migraine to determine the relative impact on migraine-associated symptoms of hydromorphone, an opioid, versus prochlorperazine, an antidopaminergic antiemetic. This was a post hoc analysis of data from a double-blind study registered at http://clinicaltrials.gov (NCT02389829). Patients who met International Classification of Headache Disorders, 3rd edition criteria for migraine without aura or for probable migraine without aura were eligible for participation. Participants received either hydromorphone 1 mg IV or prochlorperazine 10 mg IV plus diphenhydramine 25 mg IV and could receive a second dose of the same medication 1 h later if needed. The outcomes were sustained relief of nausea, photophobia, and phonophobia. A total of 127 patients were enrolled, of whom 63 received prochlorperazine and 64 received hydromorphone. Of 49 patients in the prochlorperazine arm who reported nausea at baseline, 34 (69.4%) reported complete resolution without relapse versus 15/49 (30.6%) in the hydromorphone arm (absolute risk reduction [ARR] = 38.8%, 95% CI: 20.5%-57.0%, p < 0.001). Of 55 patients in the prochlorperazine arm who reported photophobia at baseline, 23 (41.8%) reported complete resolution without relapse versus 13/62 (20.9%) patients treated with hydromorphone (ARR = 20.8%, 95% CI: 4.3%-37.3%, p = 0.014). Of 56 patients in the prochlorperazine arm who reported phonophobia at baseline, 25 (44.6%) reported complete resolution without relapse versus 16/59 (27.1%) in the hydromorphone arm (ARR = 17.5%, 95% CI: 0.3%-34.8%, p = 0.049). For adverse events, three patients in the prochlorperazine arm reported anxiety or restlessness, and nine patients in the hydromorphone arm reported dizziness or weakness. Prochlorperazine plus diphenhydramine is more efficacious than hydromorphone for the treatment of migraine-associated symptoms.
Substances chimiques
Analgesics, Opioid
0
Antiemetics
0
Diphenhydramine
8GTS82S83M
Hydromorphone
Q812464R06
Prochlorperazine
YHP6YLT61T
Banques de données
ClinicalTrials.gov
['NCT02389829']
Types de publication
Comparative Study
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
1227-1233Informations de copyright
© 2021 American Headache Society.
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