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Emerg Med J. 2007 April; 24(4): 297–300.
PMCID: PMC2658244

Chlorpromazine in migraine

Chlorpromazine in migraine

Report by Peter Loga, Staff Specialist in Emergency Medicine

Search checked by David Lewis, Consultant in Emergency Medicine

Ipswich Hospital NHS Trust, Ipswich

A short cut review was carried out to establish whether there is any evidence that chlorpromazine is an effective treatment for migraine. 81 papers were found using the reported search, of which eight answered the clinical question. The authors, patient groups, outcomes results and key weaknesses of this evidence are presented. The clinical bottom line is that a regime of prophylactic intravenous normal saline and intramuscular or intravenous chlorpromazine appears to have superior efficacy to pethidine, lignocaine or ergot derivatives, and similar efficacy to ketorolac, metoclopramide or sumatriptan for the abolition of the pain of migraine headache.

Three part question

In [patients with migraine headache] is [chlorpromazine as effective as standard treatments] at [resolving pain]?

Clinical scenario

A 38‐year‐old female with a history of regular migraine headache since her teenage years presents to your Emergency Department with a classic history of migraine symptoms. She has tried simple over the counter analgesia, as well as her prescription medication, a triptan, with no effect. You have heard of chlorpromazine being used in the abolition of migraine attacks, but are unsure of its relative efficacy compared to other standard treatments.

Search strategy

Medline OVID interface. 1966–30th Jan 2007

Cochrane Database of Systematic Reviews. 4th Quarter 2006

Cochrane Central Register of Controlled Trials. 1st Quarter 2007‐01‐31

CINAHL. 1982‐ December Week 2 2006

ACP Journal Club. 1991‐January/February 2007

EMBASE. 1966‐30th Jan 2007‐01‐31

[phenothiazines OR chlorpromazine] AND [migraine OR vascular headache]

LIMIT to English Language and Human

Search outcome

A total 81 papers were found in Medline, of which eight are directly relevant to the question. No further papers were obtained by searching Cochrane, CINAHL, EMbase or ACPJC.

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Table 3

Comment(s)

Fear of significant side effects from chlorpromazine appear to be unfounded. There was no incidence of symptomatic postural hypotension in studies which patients received prophylatic intravenous normal saline prior to chlorpromazine administration, and no dystonic reactions were reported in any study. Drowsiness is, however, frequently reported. Chlorpromazine also seems to be efficacious whether given via the intramuscular or intravenous route.

Clinical bottom line

A regime of prophylactic intravenous normal saline and intramuscular or intravenous chlorpromazine appears to have superior efficacy to pethidine, lignocaine or ergot derivatives, and similar efficacy to ketorolac, metoclopramide or sumatriptan for the abolition of the pain of migraine headache.

References

  • Iserson K V. Parenteral chlorpromazine treatment of migraine. Annals of Emergency Medicine 1983;12:756-8. [PubMed]
  • McEwen J I, O'Connor H M, Dinsdale H B. Treatment of migraine with intramuscular chlorpromazine. Annals of Emergency Medicine 1987;16:758-63. [PubMed]
  • Lane P L, McLellan B A, Baggoley C J. Comparative efficacy of chlorpromazine and meperidine with dimenhydrinate in migraine headache. Annals of Emergency Medicine 1989;18:360-5. [PubMed]
  • Bell R, Montoya D, Shuaib A. et al. A comparative trial of three agents in the treatment of acute migraine headache. Annals of Emergency Medicine 1990 Oct;19:1079-82. [PubMed]
  • Cameron J D, Lane P L. Speechley M Intravenous chlorpromazine vs intravenous metoclopramide in acute migraine headache Academic Emergency Medicine 1995;2:597-602. [PubMed]
  • Shrestha M, Singh R, Moreden J. et al. Ketorolac vs chlorpromazine in the treatment of acute migraine without aura. A prospective, randomized, double-blind trial. Archives of Internal Medicine 1996;156:1725-8. [PubMed]
  • Kelly A M, Ardagh M, Curry C. et al. Zebic S Intravenous chlorpromazine versus intramuscular sumatriptan for acute migraine Journal of Accident & Emergency Medicine 1997;14:209-11. [PMC free article] [PubMed]
  • Bigal M E, Bordini C A, Speciali J G. Intravenous chlorpromazine in the emergency department treatment of migraines: a randomized controlled trial. Journal of Emergency Medicine 2002;23:141-8. [PubMed]

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