Droperidol for the treatment of acute migraine headaches

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SCIENCE
Droperidol for the treatment of acute migraine headaches
Key Take-Away: 

Droperidol is well known for its antiemetic properties but also increases the risk of developing serious cardiac events. Thus the investigators of this study have tried to evaluate the safety and efficacy of droperidol in the treatment of acute migraine where the options for parenteral rescue therapy are limited.

To evaluate the safety and efficacy of droperidol for the relief of acute migraine headaches.

ABSTRACT: 
Background: 

To evaluate the safety and efficacy of droperidol for the relief of acute migraine headaches. 

Methods: 

The search was conducted to identify randomized controlled trials comparing droperidol with placebo or an active control in adult patients with acute migraine headaches that were published in English.

Primary end points included acute headache improvement after the intervention. Safety end points included the frequency of extra pyramidal symptoms, somnolence, and cardiac adverse effects.

Results: 

In all, 5 manuscripts are included in this review. Patients presenting to the emergency department with acute headache desire rapid pain relief, which was the primary objective in each of the evaluated studies.

Droperidol was better than placebo and at least as effective as comparator drugs such as prochlorperazine, meperidine, or olanzapine using droperidol doses of 2.5 to 5 mg, given either intramuscularly (IM) or intravenously (IV). The most common adverse effects were extra pyramidal symptoms and sedation. Cardiac adverse effects were not reported in any of the studies; however, only 2 articles described using cardiac monitoring. 

Conclusion: 

Parenteral droperidol is an effective option for the treatment of acute migraine. The minimum effective dose is 2.5 mg given IM or IV.

Parenteral droperidol is an effective option for the treatment of acute migraine. The minimum effective dose is 2.5 mg given IM or IV. Clinicians must be aware of the risk for adverse events, select appropriate patients, perform EKG monitoring for patients at risk of QTc prolongation, and institute treatment if necessary.

Ann Pharmacother 2015 Feb;49(2):233-240
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