Droperidol vs. Prochlorperazine for Benign Headaches in the Emergency Department

Miner, James R.; Fish, Sara J.; Smith, Stephen W.; Biros, Michelle H.

doi:10.1111/j.1553-2712.2001.tb01147.x

Cited by 81 publications

(58 citation statements)

References 13 publications

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“…Prior to the FDA's warning regarding the use of DROP, the drug was commonly used by emergency physicians in the ED for the treatment of vomiting, agitation, and headache [1][2][3][4][5]. A similar butyrophenone agent, haloperidol, is still commonly used for some of these same indications.…”

Section: Discussionmentioning

confidence: 99%

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The effect of IM Droperidol on driving performance

et al. 2006

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Objectives: Droperidol (DROP) is used in the emergency department (ED) for several indications, but its effect on psychomotor performance is unclear. The purpose of this study was to evaluate the effects of DROP, 2.5 mg intramuscular (IM), on driving performance.Methods: This was a randomized, double-blinded, two-period, placebo-controlled crossover trial that utilized a standard drivertraining program with computerized scoring. We solicited 20 paid volunteers who were pre-screened with a 12-lead EKG to evaluate QT length. For the first driving simulation, subjects were randomly assigned to receive either 2.5 mg of DROP IM or an equal volume of normal saline (NS). At least 72 hours later, the same subjects participated in a second driving simulation. For the second driving simulation, the assignment of DROP, 2.5 mg IM, or normal saline was reversed: (If a subject received DROP, 2.5 mg IM, in the first simulation, the subject received normal saline in the second simulation; conversely, if a subject received normal saline in the first simulation, the subject received DROP, 2.5 mg IM, in the second simulation). Thirty minutes later, participants drove the 20-minute simulation and received an average score based on the errors made in 4 categories: accelerating, braking, steering, and signaling. Post-testing, participants evaluated their degree of drowsiness and driving impairment using a visual analog scale and compared their perception of impairment to that caused by alcohol ingestion. Data were analyzed using analysis-of-variance, Pearson chisquare and Fischer's exact test with alpha set at p = 0.05.Results: Twenty subjects (11 males and 9 females) completed the protocol. The mean age was 30 years with a range of 20 to 46 years, and the mean weight was 80 kg. The mean driving experience was 12 years. Participants who received DROP felt significantly drowsier (38.6 mm +/− 9.0) than those receiving NS (13.2 mm +/− 9.0), the mean difference was 25.4 mm p = .009. Subjects receiving DROP were also more likely to feel that their driving would be impaired as rated on the VAS (DROP: 34.6 +/− 5.2; NS: 3.2 +/− 5.2; p = .0005), and DROP subjects reported impairment equivalent to 1-4 drinks more frequently than those receiving placebo (61% vs. 16.7%, p < .001). These subjective feelings of impairment were confirmed by their driving performance on the simulator. The mean driving score, using the driving simulator, was 68.8% with DROP vs. 73.6% with NS; p = .013.Conclusions: Subjects receiving modest doses of IM DROP report increased perceptions of drowsiness, driving impairment, and intoxication; these perceptions are confirmed on objective testing.

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Section: Discussionmentioning

confidence: 99%

“…IM Droperidol (DROP) has been effectively used in the emergency department (ED) setting to treat these complaints [1][2][3][4][5]. When given IM, DROP's onset of action is from 3 to 10 minutes with a peak effect at 30 minutes.…”

Section: Introductionmentioning

confidence: 99%

The effect of IM Droperidol on driving performance

et al. 2006

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“…25 Patients then completed a headache diagnosis worksheet that differentiated headache subtype based on International Headache Society (IHS) criteria as migraine, tension type, or migrainous. 5,7,26 The patient's level of consciousness was determined by the treating physician using the 9-point altered mental status (AMS) scale 27 at 0, 30, and 60 minutes. Patients who had inadequate pain control after 1 hour but before discharge were given rescue medications at the discretion of the attending physician and this rescue medication was recorded.…”

Section: Study Protocolmentioning

confidence: 99%

“…5,[8][9][10][11][12][13][14][15] In one study of 168 patients, droperidol was shown to be more effective than prochlorperazine for the treatment of primary headache. 5 Prochlorperazine, metoclopramide, and sumatripan have been shown in similarly sized studies to have equivalent effectiveness. 9,10 Because of its efficacy, droperidol is the typical treatment for primary headache in our ED.…”

mentioning

confidence: 99%

“…2 These headaches are known as primary headaches and include the diagnoses of migraine, cluster, and tension-type headaches. [3][4][5][6][7] While the subdivisions of primary headache are important for long-term therapeutic interventions, recent studies suggest that in the acute setting, it is reasonable to treat primary headache as a single entity. In this study, we evaluated all patients with primary headache as a single diagnosis.…”

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confidence: 99%

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Olanzapine versus Droperidol for the Treatment of Primary Headache in the Emergency Department

Hill

Miner

Martel

2008

Academic Emergency Medicine

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Objectives: The objective was to determine if there is a difference in pain relief or frequency and severity of side effects in emergency department (ED) patients with primary headache treated with either intramuscular (IM) olanzapine or IM droperidol.Methods: This was a prospective, randomized nonblinded clinical trial of adult ED patients undergoing treatment for suspected primary headache. Consenting patients were randomized to receive either droperidol 5 mg IM or olanzapine 10 mg IM. Prior to receiving treatment, patients were asked to complete a 100-mm visual analog scale (VAS) describing their pain and a 4-point verbal rating scale (VRS) describing their pain as none, mild, moderate, or severe. Patients also completed a 100-mm VAS describing their level of nausea. Pain and nausea measurements were repeated 30 and 60 minutes after medication administration. Patients also completed the Barnes Akathisia Scale (BAS) 30 and 60 minutes after medication administration. Descriptive statistics were used as appropriate. Pain relief was compared both in terms of the decrease in VAS scores and in the proportion of patients who reported moderate or severe pain whose report later changed to mild or no pain.Results: One-hundred patients were enrolled; 13 were withdrawn before administration of the study medication, 8 in the droperidol group and 5 in the olanzapine group, leaving 87 patients for analysis. Forty-two patients received droperidol and 45 received olanzapine. In the droperidol group, 35 ⁄ 40 (87.5%) patients who had reported moderate or severe pain at baseline reported mild or no pain at 60 minutes. In the olanzapine group, 38 ⁄ 44 (86.4%) reported this change (p = 0.89). The mean percent change from baseline VAS pain score at 60 minutes was )37% (95% CI = )84% to 11%) for droperidol and )37% (95% CI = )64% to 10%) for olanzapine (p = 0.30). The mean percent change from baseline for the VAS nausea score was )59% (95% CI = )70% to )47%) for droperidol and )64% (95% CI = )77% to )51%) for olanzapine (p = 0.83). There was no difference in any report of akathisia by the BAS between the groups (p = 0.63).Conclusions: Both olanzapine and droperidol are effective treatments for primary headaches in the ED. No significant differences were found between the medications in terms of pain relief, antiemetic effect, or akathisia. Olanzapine may be used to treat primary headache and it is an effective alternative to droperidol. ACADEMIC EMERGENCY MEDICINE 2008; 15:806-811 ª 2008 by the Society for Academic Emergency MedicineKeywords: emergency department, headache, migraine, treatment, droperidol, olanzapine H eadaches present a frequent diagnostic and therapeutic challenge in the emergency department (ED), accounting for more than 3 million ED visits a year. This makes headaches, representing 2.7% of all ED visits, a more common complaint than back pain.1 While a headache can be a sign of serious and potentially life-threatening pathology, 90% of headaches encountered in the ED are benign and are not secondary to o...

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Dopamine antagonists and migraine

McGeeney

2007

Drug Development Research

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Migraine is common impairing disorder resulting from activation of the trigeminovascular system. Evidence suggests that dopaminergic mechanisms are important in migraine, including the premonitory phase. Dopamine antagonists have been used successfully as a primary therapy for migraine in urgent care settings and as adjuvant therapy on an outpatient basis. Experience and clinical studies have shaped the current use of dopamine antagonists, in particular prochlorperazine and metoclopromide. All commonly used dopamine antagonists have other receptor affinities that may also be important for efficacy and side effects. This review outlines the main dopamine antagonists used to treat migraine with supportive evidence and typical side effects. Drug Dev Res 68:341-345, 2007.

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Droperidol vs. Prochlorperazine for Benign Headaches in the Emergency Department

Cited by 81 publications

References 13 publications

The effect of IM Droperidol on driving performance

The effect of IM Droperidol on driving performance

Olanzapine versus Droperidol for the Treatment of Primary Headache in the Emergency Department

Dopamine antagonists and migraine

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