By Robert Preidt
Acute migraine -- an intense, throbbing headache that may be accompanied by visual disturbances and sensitivity to light and sound -- is a disabling condition that results in 1.2 million visits to U.S. emergency rooms each year.
The opioid painkiller "hydromorphone is given in about 25 percent 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 Dr. Peter Goadsby, chairman of the American Headache Society's Scientific Program Committee.
The new study was led by Dr. Benjamin Friedman of Albert Einstein College of Medicine in New York City. The evaluation included 126 patients with acute migraine treated at two New York City emergency departments. They received either prochlorperazine (Compro) plus diphenhydramine (Benadryl), or hydromorphone (Dilaudid).
Patients were assessed for sustained headache relief. That was defined as a reduction in severity to either mild or no headache within two hours of treatment, and maintaining that level for 48 hours after one dose of medication.
Sixty percent of patients who took prochlorperazine had sustained relief, compared to 31 percent in the hydromorphone group. The study was stopped early because the difference was so large.
"This study is important in providing clear evidence that hydromorphone is significantly less effective than prochlorperazine in achieving and maintaining headache relief," Goadsby said in a society news release.
The new findings support society treatment recommendations for adults who seek emergency care for acute migraine, he said.
"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," Goadsby said.
The findings were presented recently at the annual meeting of the American Headache Society, in Boston. Research presented at medical meetings is typically considered preliminary because it is not subject to the same scrutiny as that of peer-reviewed journals.