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Are butyrophenones effective for the treatment of primary headache in the emergency department?

Published online by Cambridge University Press:  11 May 2015

Lim Beng Leong  and
Anne-Maree Kelly
Lim Beng Leong*
Affiliation:
Emergency Department, Tan Tock Seng Hospital, Singapore
Anne-Maree Kelly
Affiliation:
Joseph Epstein Centre for Emergency Medicine Research at Western Health and The University of Melbourne, Australia
*
Tan Tock Seng Emergency Department, 11, Jalan Tan Tock Seng, Singapore 308433; Beng_Leong_Lim@ttsh.com.sg

Abstract

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Objectives:

Butyrophenones have been reported to provide effective migraine relief in the emergency department (ED). We conducted a systematic review of the evidence for their use in the ED.

Data source:

We searched the Cochrane, Medline, Embase, and CINAHL databases.

Study selection:

Included studies were randomized trials of a parenteral butyrophenone (droperidol, haloperidol) versus placebo or a comparator in migraine or benign headache with results available in English. Study quality was determined using the Jadad score. Six articles were included.

Data extraction:

Primary outcomes were subjective or objective headache relief (> 50% improvement in visual analogue scale scores). Secondary outcomes included side effects. We reported pooled odds ratios (ORs) with their 95% confidence intervals (CIs) for subjective or objective headache relief for butyrophenones versus placebo or comparator agents.

Data synthesis:

Three studies reported subjective headache relief with a butyrophenone versus placebo or meperidine in migraine. Two studies reported objective headache relief with droperidol versus prochlorperazine, whereas one study compared droperidol versus olanzapine in benign headache. The pooled OR for subjective headache relief was 8.08 (95% CI 1.54–42.30) for a butyrophenone versus placebo, whereas it was 1.50 (95% CI 0.33–6.77) for droperidol versus meperidine in migraine. The pooled OR for objective headache relief was 2.96 (95% CI 1.36–6.43) for droperidol versus prochlorperazine in benign headache. Rates of side effects were 10 to 45%; akathesia and sedation were the most common.

Conclusions:

Butyrophenones are effective for the relief of migraine or benign headache. However, adverse effects make it difficult to recommend butyrophenones above agents with similar effectiveness and fewer problems.

Keywords

butyrophenonesemergencymigraine
Type
State of the Art • À la fine pointe
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 2 , March 2011 , pp. 96 - 104
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

References

REFERENCES

1.Vinson, DR. Treatment patterns of isolated benign headaches in US emergency departments. Ann Emerg Med 2002;39:215–22.Google Scholar
2.Silberstein, SD, Saper, JR, Freitag, F. Migraine: diagnosis and treatment. In: Silberstein, SD, Lipton, RB, Dalessio, DJ, editors. Wolff’s headache and other head pain. 7th ed. New York: Oxford University Press, 2001. p. 121–237.Google Scholar
3.Colman, I, Rothney, A, Wright, SC, et al. Use of narcotic analgesics in the emergency department treatment of migraine headache. Neurology 2004;62:1695–700.CrossRefGoogle ScholarPubMed
4.Friedman, BW, Kapoor, A, Friedman, MS, et al. The relative efficacy of meperidine for the treatment of acute migraine: a meta-analysis of randomized controlled trials. Ann Emerg Med 2008;52:705–13.CrossRefGoogle Scholar
5.Bigal, ME, Lipton, RB. Excessive acute migraine medication use and migraine progression. Neurology 2008;71:1821–8.CrossRefGoogle ScholarPubMed
6.Dodick, D, Lipton, RB, Martin, V, et al. Consensus statement: cardiovascular safety profile of triptans (5-HT1B/1D agonists) in the acute treatment of migraine. Headache 2004;44:414–25.Google Scholar
7.Richman, PB, Reischel, U, Ostrow, A, et al. Droperidol for acute migraine headache. Am J Emerg Med 1999;17:398–400.CrossRefGoogle ScholarPubMed
8.Fisher, H. A new approach to emergency department therapy of migraine headache with intravenous haloperidol: a case series. J Emerg Med 1995;13:119–22.CrossRefGoogle ScholarPubMed
9.Mascia, A, Afra, J, Schoenen, J. Dopamine and migraine: a review of pharmacological, biochemical, neurophysiological, and therapeutic data. Cephalalgia 1998;18:174–82.Google Scholar
10.Trainor, A, Miner, J. Pain treatment and relief among patients with primary headache subtypes in the ED. Am J Emerg Med 2008;26:1029–34.CrossRefGoogle ScholarPubMed
11.Jadad, AR, Moore, RA, Carroll, D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:1–12.CrossRefGoogle ScholarPubMed
12.International Headache Society Committee on Clinical Trials in Migraine. Guidelines for controlled trials of drugs in migraine. First edition. Cephalalgia 1991;11:1–12.CrossRefGoogle Scholar
13.Honkaniemi, J, Liimatainen, S, Rainesalo, S. Haloperidol in the acute treatment of migraine: a randomized, double blind, placebo controlled study. Headache 2006;46:781–7.Google Scholar
14.Silberstein, SD, Young, WB, Mendizabal, JE, et al. Acute migraine treatment with droperidol: a randomized double blind, placebo controlled trial. Neurology 2003;60:315–21.CrossRefGoogle ScholarPubMed
15.Richman, PB, Allegra, J, Eskin, B, et al. A randomized clinical trial to assess the efficacy of intramuscular droperidol for the treatment of acute migraine headache. Am J Emerg Med 2002;20:39–42.CrossRefGoogle ScholarPubMed
16.Miner, JR, Fish, SJ, Smith, SW, et al. Droperidol vs. prochlorperazine for benign headaches in the emergency department. Acad Emerg Med 2001;8:873–9.Google Scholar
17.Weaver, CS, Jones, JB, Chisholm, CD, et al. Droperidol vs. prochlorperazine for the treatment of acute headache. J Emerg Med 2004;2:145–50.CrossRefGoogle Scholar
18.Hill, CH, Miner, JR, Martel, ML. Olanzapine versus droperidol for the treatment of primary headache in the emergency department. Acad Emerg Med 2008;15:806–11.Google Scholar
19.Kelly, AM. Specific pain syndromes: Headache. In: Mace, S, Ducharme, J, Murphy, M, editors. Pain management and sedation: emergency department management. New York: McGraw-Hill, 2006. p. 279–86.Google Scholar
20.Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988;8:1–96.Google Scholar
21.Jackson, CW, Sheehan, AH, Reddan, JG. Evidence-based review of the black-box warning for droperidol. Am J Health Syst Pharm 2007;64:1174–86.Google Scholar
22.Nuttall, GA, Eckerman, KM, Jacob, KA, et al. Does low dose droperidol administration increase the risk of drug induced QT prolongation and torsades de pointes in the general surgical population? Anesthesiology 2007;107:531–6.Google Scholar
23.Fortney, J, Gan, T, Graczyk, S, et al. A comparison of the efficacy, safety and patient satisfaction of ondansetron versus droperidol as anti-emetics for elective outpatient surgical procedures. S3A-09 and S3A-410 study groups. Anesth Analg 1998;86:731–8.Google Scholar
24.Chase, PB, Biros, MH. A retrospective review of the use and safety of droperidol in a large, high risk inner city emergency department patient population. Acad Emerg Med 2002;9:1402–10.Google Scholar
25.Dershwitz, M. There should be a threshold dose for the FDA black-box warning on droperidol. Anesth Analg 2003;97:1542–3.CrossRefGoogle Scholar
26.Lischke, V, Behne, M, Doelken, P, et al. Droperidol causes a dose dependent prolongation of the QT interval. Anesth Analg 1994;79:983–6.Google Scholar