Benjamin W. Friedman, MD, MS
Are phenothiazines better than placebo or other active agents for relief of acute migraine headaches?
Included studies compared parenteral phenothiazines (chlorpromazine, prochlorperazine, and methotrimeprazine) with placebo or other active parenteral agents for treatment of acute migraine headaches in adults and reported headache intensity or clinical outcome ≤ 2 hours after treatment. Outcomes were headache relief and study-defined clinical success or use of rescue medication if clinical success was not reported.
MEDLINE, EMBASE/Excerpta Medica, CINAHL, Cochrane database, and international clinical trial registers were searched up to December 2008 for fully published, randomized, controlled trials (RCTs). 13 RCTs met the selection criteria: 6 used chlorpromazine, 6 used prochlorperazine, and 1 used methotrimeprazine. 3 RCTs had placebo controls, 8 had active controls (metoclopramide, meperidine, ketorolac, valproate, or sumatriptan), and 2 had both. All trials were conducted in emergency departments. 11 of 13 RCTs had Jadad scale scores ≥ 4 out of 5.
Meta-analysis showed that phenothiazines were better than placebo or other active agents for successfully treating acute migraine headaches (Table). Meta-analysis showed that phenothiazines were also better than placebo but did not differ from other active treatment agents for complete relief of acute migraine headaches (Table).
Phenothiazines are more effective than placebo for treating acute migraine headaches in the emergency department and are better than other active agents for clinical success but not complete headache relief.
Phenothiazines for treatment of acute migraine in the emergency department*
*Abbreviations defined in Glossary. RBI, NNT, and CI calculated from data in article using a random-effects model.
†Outcomes defined by individual studies.
Friedman BW. Review: Phenothiazines relieve acute migraine headaches in the ED and are better than other active agents for some outcomes. Ann Intern Med. ;152:JC4–11. doi: 10.7326/0003-4819-152-8-201004200-02011
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Published: Ann Intern Med. 2010;152(8):JC4-11.
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