Acute migraine treatment with droperidol

Silberstein, SD; Young, William B.; Mendizabal, Jorge E.; Rothrock, John F.; Alam, Aftab

doi:10.1212/01.wnl.0000042477.63516.b2

Cited by 114 publications

(88 citation statements)

References 25 publications

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“…Three studies reported proportions of patients with subjective headache relief 1 to 3 hours post administration of a butyrophenone compared to placebo or meperidine in the treatment of migraine. [13][14][15] The weighted average rate of subjective headache relief 1 to 3 hours after treatment by a butyrophenone in these three trials was 82.8% (n 5 216).…”

Section: Resultsmentioning

confidence: 94%

“…Two of these studies compared a butyrophenone to placebo in the treatment of migraine. 13,14 One compared intravenous (IV) haloperidol to placebo, 13 whereas the other compared intramuscular (IM) droperidol to placebo using four different dosage regimens. 14 The remaining four studies compared parenteral droperidol to a comparator drug in the treatment of migraine or benign headache.…”

Section: Resultsmentioning

confidence: 99%

“…13,14 One compared intravenous (IV) haloperidol to placebo, 13 whereas the other compared intramuscular (IM) droperidol to placebo using four different dosage regimens. 14 The remaining four studies compared parenteral droperidol to a comparator drug in the treatment of migraine or benign headache. [15][16][17][18] The comparator drugs were meperidine, prochlorperazine, or olanzapine.…”

Section: Resultsmentioning

confidence: 99%

“…Although three of the six studies included used the classification by the International Headache Society 20 to define migraine, [13][14][15] we included three studies that investigated the use of droperidol in benign headache. [16][17][18] We included them as we wanted to reflect the ''real world'' of the ED.…”

Section: Discussionmentioning

confidence: 99%

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

Leong

Kelly

2011

CJEM

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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. RÉ SUMÉObjectif : Il a é té signalé que les butyrophé nones soulageaient les migraines dans les services d'urgence. Nous avons procé dé à une analyse systé matique sur leur utilisation à l'urgence. Source des donné es : Nous avons interrogé les bases de donné es Cochrane, Medline, Embase et CINAHL. Sé lection des é tudes : Nous avons retenu les essais randomisé s d'un butyrophé none parenté ral (dropé ridol, halopé ridol) contre un placebo ou un comparateur en cas de migraine ou de cé phalé e bé nigne. Les ré sultats devaient ê tre disponibles en anglais. Nous avons é valué la qualité des essais selon le score de Jadad. Six articles ont é té retenus. Extraction des donné es : Les principaux critè res d'é valuation é taient le soulagement subjectif ou objectif de maux de tê te (. 50 % d'amé lioration selon l'é chelle visuelle analogique). Les critè res secondaires d'é valuation é taient entre autres les effets secondaires. Nous avons inclus les rapports de cotes combiné s (RC) avec intervalle de confiance à 95 % (IC) pour le soulagement subjectif ou objectif de maux de tê te pour le groupe butyrophé nones par rapport au groupe placebo ou autres comparateurs. Synthè se des donné es : Trois é tudes ont signal...

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Leong

Kelly

2011

CJEM

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“…Multiple clinical trials have showed superior effect compared to placebo, SC sumatriptan and sodium valproate [54][55][56][57]. Intravenous droperidol [58,59] is effective in status migranosus and more effective than placebo in controlled trials for acute migraine. Multiple studies also support the use of chlorpromazine [60,61], haloperidol [62], and metoclopramide [63,64] with or in conjunction with DHE treatment.…”

mentioning

confidence: 99%

Inpatient Management of Migraine

Marmura

Goldberg

2015

Curr Neurol Neurosci Rep

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Acute Treatments for Episodic Migraine in Adults

VanderPluym

Singh

Urtecho

et al. 2021

JAMA

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IMPORTANCEMigraine is common and can be associated with significant morbidity, and several treatment options exist for acute therapy.OBJECTIVE To evaluate the benefits and harms associated with acute treatments for episodic migraine in adults.DATA SOURCES Multiple databases from database inception to February 24, 2021.STUDY SELECTION Randomized clinical trials and systematic reviews that assessed effectiveness or harms of acute therapy for migraine attacks.DATA EXTRACTION AND SYNTHESIS Independent reviewers selected studies and extracted data. Meta-analysis was performed with the DerSimonian-Laird random-effects model with Hartung-Knapp-Sidik-Jonkman variance correction or by using a fixed-effect model based on the Mantel-Haenszel method if the number of studies was small. MAIN OUTCOMES AND MEASURESThe main outcomes included pain freedom, pain relief, sustained pain freedom, sustained pain relief, and adverse events. The strength of evidence (SOE) was graded with the Agency for Healthcare Research and Quality Methods Guide for Effectiveness and Comparative Effectiveness Reviews.FINDINGS Evidence on triptans and nonsteroidal anti-inflammatory drugs was summarized from 15 systematic reviews. For other interventions, 115 randomized clinical trials with 28 803 patients were included. Compared with placebo, triptans and nonsteroidal anti-inflammatory drugs used individually were significantly associated with reduced pain at 2 hours and 1 day (moderate to high SOE) and increased risk of mild and transient adverse events. Compared with placebo, calcitonin gene-related peptide receptor antagonists (low to high SOE), lasmiditan (5-HT 1F receptor agonist; high SOE), dihydroergotamine (moderate to high SOE), ergotamine plus caffeine (moderate SOE), acetaminophen (moderate SOE), antiemetics (low SOE), butorphanol (low SOE), and tramadol in combination with acetaminophen (low SOE) were significantly associated with pain reduction and increase in mild adverse events. The findings for opioids were based on low or insufficient SOE. Several nonpharmacologic treatments were significantly associated with improved pain, including remote electrical neuromodulation (moderate SOE), transcranial magnetic stimulation (low SOE), external trigeminal nerve stimulation (low SOE), and noninvasive vagus nerve stimulation (moderate SOE). No significant difference in adverse events was found between nonpharmacologic treatments and sham.CONCLUSIONS AND RELEVANCE There are several acute treatments for migraine, with varying strength of supporting evidence. Use of triptans, nonsteroidal anti-inflammatory drugs, acetaminophen, dihydroergotamine, calcitonin gene-related peptide antagonists, lasmiditan, and some nonpharmacologic treatments was associated with improved pain and function. The evidence for many other interventions, including opioids, was limited.

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Acute migraine treatment with droperidol

Cited by 114 publications

References 25 publications

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

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

Inpatient Management of Migraine

Acute Treatments for Episodic Migraine in Adults

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