|Home | About | Journals | Submit | Contact Us | Français|
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.
In [patients with migraine headache] is [chlorpromazine as effective as standard treatments] at [resolving pain]?
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.
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
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.
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.
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.