M Shrestha1, R Singh, J Moreden, J E Hayes. 1. Division of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, USA.
Abstract
BACKGROUND: Many treatments for acute migraine exist. Chlorpromazine is effective but has serious side effects. Ketorolac has only rare side effects. OBJECTIVE: To compare intramuscular ketorolac troinethamine with intravenous chlorpromazine hydrochloride in treating acute migraine. METHODS: We performed a prospective, randomized, double-blind trial comparing the clinical effectiveness of 60 mg of intramuscular ketorolac tromethamine with 25 mg of intravenous chlorpromazine hydrochloride in patients with acute migraine headache seen in the emergency department. Pain intensity, quantitated using the Wong-Baker Faces Rating Scale, was measured every 30 minutes for 2 hours in the emergency department. Patients returned pain scores at 6, 12, 24, and 48 hours by mail. RESULTS:Fifteen patients were entered into each treatment arm. No differences were seen between the mean pain scores or the mean change in pain scores. The ketorolac group mean (+/- SEM) pain score decreased from 4.07 +/- 0.18 to 0.73 +/- 0.3 in 2 hours. The chlorpromazine group pain score decreased from 4.47 +/- 0.17 to 0.87 +/- 0.4. Two of the 3 nonresponders responded to the alternate group's treatment. No side effects were seen. CONCLUSIONS: Using 60 mg of intramuscular ketorolac tromethamine is as effective as 25 mg of intravenous chlorpromazine hydrochloride in the treatment of acute migraine headache. Patients who do not respond to one of these medications may respond to the other.
RCT Entities:
BACKGROUND: Many treatments for acute migraine exist. Chlorpromazine is effective but has serious side effects. Ketorolac has only rare side effects. OBJECTIVE: To compare intramuscular ketorolac troinethamine with intravenous chlorpromazine hydrochloride in treating acute migraine. METHODS: We performed a prospective, randomized, double-blind trial comparing the clinical effectiveness of 60 mg of intramuscular ketorolac tromethamine with 25 mg of intravenous chlorpromazine hydrochloride in patients with acute migraine headache seen in the emergency department. Pain intensity, quantitated using the Wong-Baker Faces Rating Scale, was measured every 30 minutes for 2 hours in the emergency department. Patients returned pain scores at 6, 12, 24, and 48 hours by mail. RESULTS: Fifteen patients were entered into each treatment arm. No differences were seen between the mean pain scores or the mean change in pain scores. The ketorolac group mean (+/- SEM) pain score decreased from 4.07 +/- 0.18 to 0.73 +/- 0.3 in 2 hours. The chlorpromazine group pain score decreased from 4.47 +/- 0.17 to 0.87 +/- 0.4. Two of the 3 nonresponders responded to the alternate group's treatment. No side effects were seen. CONCLUSIONS: Using 60 mg of intramuscular ketorolac tromethamine is as effective as 25 mg of intravenous chlorpromazine hydrochloride in the treatment of acute migraine headache. Patients who do not respond to one of these medications may respond to the other.