Intravenous Chlorpromazine vs Intravenous Metoclopramide in Acute Migraine Headache

• Published in: Academic emergency medicine Vol. 2; no. 7; pp. 597 - 602
• Main Authors: Cameron, James D., Lane, Peter L., Speechley, Mark
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.1995
• Subjects: Acute Disease; Adolescent; Adult; Aged; chlorpromazine; Chlorpromazine - administration & dosage; Chlorpromazine - adverse effects; Chlorpromazine - therapeutic use; Dopamine Antagonists - administration & dosage; Dopamine Antagonists - adverse effects; Dopamine Antagonists - therapeutic use; Double-Blind Method; Emergency Service, Hospital; Female; Humans; Injections, Intravenous; Male; metoclopramide; Metoclopramide - administration & dosage; Metoclopramide - adverse effects; Metoclopramide - therapeutic use; Middle Aged; Migraine Disorders - drug therapy; migraine headache; Prospective Studies; Treatment Outcome
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1111/j.1553-2712.1995.tb03596.x

ABSTRACT Objective: To compare the efficacy of IV chlorpromazine with that of IV metoclopramide in the treatment for acute migraine headache in the ED. Methods: A prospective randomized double‐blind trial was undertaken at two university‐affiliated urban EDs with a combined annual census of more than 85,000 patients. Included in the study were patients presenting to the ED with a diagnosis of migraine headache. The subjects were randomized to receive 0.1 mg/kg/dose IV of either chlorpromazine (CPZ) or metoclopramide (MC), up to a total of three doses. Results: Ninety‐one patients completed the protocol; 44 received MC and 47 received CPZ. The demographics of the two groups were similar. Both drugs provided, for the majority of patients, adequate pain relief as measured on a visual analog scale (VAS) completed every 15 minutes from T = 0 minutes to T = 45 minutes. The average pain relief over 45 minutes (ΔVAS) for CPZ was 4.87 cm, vs 4.34 cm for MC (p = 0.35). There also was no statistically significant difference in blood pressure (BP) changes (ΔBP < 2 mm Hg for both systolic and diastolic BPs, p = 0.47 and 0.33) or numbers of patients reporting adverse effects (AEs) (CPZ: 16 of 35; MC: 13 of 29, p = 0.43). There was no severe AE with either study drug. Conclusions: Metoclopramide and chlorpromazine administered IV are both effective in the management of acute migraine headache. They are associated with similar minor side‐effect profiles.