SAFETY AND EFFICACY OF RECTAL PROCHLORPERAZINE FOR THE TREATMENT OF MIGRAINE IN THE EMERGENCY DEPARTMENT

Study objective: To assess the safety and efficacy of rectal prochlorperazine in the treatment of acute migraines. Design: Randomized, double-blinded, placebo-controlled study. Setting: Emergency department of an inner-city university hospital. Participants: ED patients with documented diagnosis of migraines. Interventions: Vital signs and level of alertness were monitored immediately before drug administration and 120 minutes after dosing. Pain intensity and adverse events were monitored immediately before drug administration and at 30, 60, and 120 minutes after dosing. Results: A positive outcome was defined as a pain score less than or equal to 5 on a 10-point scale or a 50% reduction in pain intensity from baseline at 120 minutes after dosing. All patients treated with prochlorperazine suppositories experienced a positive treatment outcome; only 50% of patients treated with placebo experienced a positive result at 120 minutes after dosing (P=.016). Pain intensity scores were significantly lower in the prochlorperazine group at 120 minutes (P=.018). There were no adverse reactions in either group, and there were no significant differences in vital signs or levels of alertness between groups. Patients who failed therapy were given rescue medication 120 minutes after dosing. Conclusion: Prochlorperazine administered as a 25-mg rectal suppository provides excellent pain relief within 2 hours in patients with acute migraines.