Intravenous Haloperidol vs. Intravenous Metoclopramide for Acute Migraine Therapy in the Emergency Department

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SCIENCE
Intravenous Haloperidol vs. Intravenous Metoclopramide for Acute Migraine Therapy in the Emergency Department
Key Take-Away: 

Apart from being the first choice drug in the treatment of schizophrenia, haloperidol has also shown its effectiveness in migraine treatment. In this study, the investigators have been successful in evaluating the comparable safety and efficacy of haloperidol with metoclopramide.

Emergency Department (ED) headache patients are commonly treated with neuroleptic antiemetics like metoclopramide. Haloperidol has been shown to be effective for migraine treatment. In this study, we compared the use of metoclopramide vs. haloperidol to treat ED migraine patients.

ABSTRACT: 
Background: 

Emergency Department (ED) headache patients are commonly treated with neuroleptic antiemetics like metoclopramide.

Haloperidol has been shown to be effective for migraine treatment. In this study, we compared the use of metoclopramide vs. haloperidol to treat ED migraine patients.

Methods: 

A prospective, double-blinded, randomized control trial of 64 adults aged 18–50 years with migraine headache and no recognized risks for QT-prolongation.

Haloperidol 5 mg or metoclopramide 10 mg was given intravenously after 25 mg diphenhydramine. Pain, nausea, restlessness (akathisia), and sedation were assessed with 100-mm visual analog scales (VAS) at baseline and every 20 min, to a maximum of 80 min. The need for rescue medications, side effects, and subject satisfaction were recorded. QTc intervals were measured prior to and after treatment. Follow-up calls after 48 h assessed satisfaction and recurrent or persistent symptoms.

Results: 

Thirty-one subjects received haloperidol, 33 metoclopramide. The groups were similar on all VAS measurements, side effects, and in their satisfaction with therapy.

Pain relief averaged 53 mm VAS over both groups, with equal times to maximum improvement. Subjects receiving haloperidol required rescue medication significantly less often (3% vs. 24%, p < 0.02). Mean QTcs were equal and normal in the two groups and did not change after treatment. In telephone follow-up, 90% of subjects contacted were “happy with the medication” they had received, with haloperidol-treated subjects experiencing more restlessness (43% vs. 10%).

Conclusion: 

Intravenous haloperidol is as safe and effective as metoclopramide for the ED treatment of migraine headaches, with less frequent need for rescue medications.

J Emerg Med. 2015 Jun 2

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