INTRAVENOUS CHLORPROMAZINE VS INTRAVENOUS METOCLOPRAMIDE IN ACUTE MIGRAINE HEADACHE

Objective: To compare the efficacy of IV chlorpromazine with that of IV metoclopramide in the treatment for acute migraine in the ED. Methods: A prospective randomized double-blind trial was under taken 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 (Delta VAS) 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 (Delta BP < 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 acute migraine headache. They are associated with similar minor side-effect profiles.