The Efficacy and Safety of Prochlorperazine in Patients With Acute Migraine: A Systematic Review and Meta-Analysis.

Abstract

The aim of this review was to evaluate the efficacy and safety of prochlorperazine (PCP) in patients with acute migraine headache in the emergency department (ED). Electronic databases (Medline, Scopus, Web of Science, and Cochrane) were searched for randomized clinical trials that investigated the effect of PCP on headache relief. The outcomes were the number of patients without headache or with reduced headache severity, the number of adverse events, and the need for rescue analgesia. From 450 citations, 11 studies (n=771) with 15 comparison arms met the inclusion criteria. Overall, PCP was more effective than placebo (OR=7.23; 95% CI=3.82-3.68), metoclopramide (OR=2.89; 95% CI=1.42-5.86), and other active comparators (OR=3.70; 95% CI=2.41-5.67) for headache relief. The odds ratio of experiencing adverse events with PCP compared with placebo was 5.79 (95% CI=2.43-13.79). When PCP compared with other active comparators, no statistical difference was found regarding the overall number of adverse events (OR=1.88; 95% CI=0.99-3.59). However, PCP significantly increased the odds of akathisia/dystonia (OR=2.55; 95% CI=1.03-6.31). The request for rescue analgesia was significantly lower in the PCP group compared with other groups (16% vs 84%; OR=0.16; 95% CI=0.09-27). For adult patients with acute migraine, PCP could effectively abort the acute attack and reduce the request for rescue analgesia in the ED. However, compared with placebo, PCP could increase the risk of adverse events.