Study Shows Prochlorperazine is More Effective than the Opioid Hydromorphone for Acute Migraine, a Disabling Condition that Causes 1.2 million Visits to US Emergency Departments per Year
First Randomized Double-Blind Comparative Study of These Drugs for Emergency Department Migraine Visits
Boston, June 7, 2017 – A new comparative study shows that, in patients who visit the emergency department for acute migraine treatment, prochorperazine is more effective than the opioid drug, hydromorphone. The difference was so substantial that the trial was halted early. The findings are being presented at this year’ 59th annual meeting of the American Headache Society, taking place June 8 – 11, 2017 in Boston, Massachusetts.
“Hydromorphone is given in about 25% of all emergency department visits for acute migraine. However, it’s well known that the use of prescription opioids can lead to serious risks of addiction, abuse, and overdose and adversely impact treatment of migraine,” said Peter Goadsby, MD, PhD, FAHS, AHS scientific program committee Chair, professor of neurology at King’s College, London and University of California, San Francisco and Director of NIHR-Wellcome Trust Clinical Research Facility, King’s College Hospital, London. “This study is important in providing clear evidence that hydromorphone is significantly less effective than prochlorperazine in achieving and maintaining headache relief.”
The randomized, double-blind, comparative study was conducted in two emergency departments (EDs) in New York City. Qualifying patients visiting the ED for acute migraine treatment were assigned to receive prochlorperazine 10 mg plus diphenhydramine 25 mg, or hydromorphone 1 mg. The primary outcome was sustained headache relief, defined as a reduction in severity to either mild or none within two hours of treatment, and maintaining that level for 48 hours after one medication dose.
The results showed that sustained headache relief was achieved by significantly more patients in the prochlorperazine group compared to the hydromorphone group: 60% vs. 31%. The trial was halted early because the results were clear and continued administration of the less-effective treatment, hydromorphone, would raise ethical issues.
“These new findings support the American Headache Society treatment recommendations for adults presenting to the emergency department with acute migraine,” said Dr. Goadsby. “Physicians should first offer these patients intravenous prochlorperazine, metoclopramide, or subcutaneous sumatriptan, but not morphine or hydromorphone because of a lack of evidence for efficacy and concerns about side effects,” he said.
Migraine is a major disabling neurological disease that affects more than 36 million men, women and children in the United States, more than have asthma or diabetes combined. Individuals who experience migraine have symptoms that include nausea, sensitivity to light and/or odors, skin sensitivity, fatigue, mood change, dizziness, difficulty concentrating, neck pain and changes in vision, including seeing spots, stars, lines, flashing lights and zigzag lines. Migraine impacts one in four households, one in five women, one in 16 men and one in 11 children in the United States. Globally, migraine is the sixth highest cause of years of life lost due to disability and can be extremely disabling and costly, accounting for more than $20 billion in direct (e.g. doctor visits, medications) and indirect (e.g. missed work, lost productivity) expenses each year in the United States. Acute migraine causes 1.2 million visits to US emergency departments annually.
About the American Headache Society
The American Headache Society (AHS) is a professional society of health care providers dedicated to the study and treatment of headache and face pain. The Society’s objectives are to promote the exchange of information and ideas concerning the causes and treatments of headache and related painful disorders. Educating physicians, health professionals and the public and encouraging scientific research are the primary functions of this organization. AHS activities include an annual scientific meeting, a comprehensive headache symposium, regional symposia for neurologists and family practice physicians, and publication of the journal Headache. More information can be found at www.americanheadachesociety.org. In 2010 AHS founded the American Migraine Foundation (AMF) to provide access to information and resources for individuals living with migraine, as well as their loved ones. AMF is a non-profit organization dedicated to the advancement of research and awareness surrounding migraine. Patients can learn more, find help and get connected by visiting www.americanmigrainefoundation.org.