Comparative efficacy of chlorpromazine and meperidine with dimenhydrinate in
migraine headache.
Author(s): Lane PL, McLellan BA, Baggoley CJ.
Affiliation(s): Department of Emergency Services, Sunnybrook Medical Centre, University of
Toronto, Canada.
Publication date & source: 1989, Ann Emerg Med. , 18(4):360-5
Approximately 20% of the population suffers from migraine headache, and a
significant number develop "fixed" migraines, refractory to oral medications. Of
this group, many become habitual narcotic users. A previously published case
series using IV chlorpromazine suggested efficacy, so a randomized, double-blind,
controlled trial was conducted. The study compared IV chlorpromazine against IV
meperidine with dimenhydrinate. Entry criteria were emergency department patients
from 18 to 60 years of age with a clinical diagnosis of common or classic
migraine headache. After informed consent was obtained, an IV line with normal
saline was established, and a bolus of 5 mL/kg was administered. Patients were
randomized into two groups: chlorpromazine and meperidine with dimenhydrinate.
The chlorpromazine group received a bolus injection of 5 mL normal saline placebo
followed by 0.4 mL/kg chlorpromazine solution (0.1 mg/kg). The chlorpromazine was
repeated every 15 minutes as needed up to a total of three doses. The meperidine
with dimenhydrinate group received 5 mL dimenhydrinate solution (25 mg) followed
by 0.04 mL/kg meperidine (0.4 mg/kg). Again, the meperidine solution was repeated
in the same dosage every 15 minutes as needed up to a total of three doses. If
response was inadequate 15 minutes after the third dose, the sequence was broken,
and the other medication given. Blood pressure and response were assessed at
15-minute intervals for one hour. Pain was assessed by both visual and verbal
analogue scales every 15 minutes. In all, 46 patients were entered in the study
(24 chlorpromazine and 22 meperidine with dimenhydrinate).(ABSTRACT TRUNCATED AT
250 WORDS)
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