Opioid vs Non-Opioid: Which Is Best for Migraine?

A non-opioid treatment option is significantly more effective at relieving pain in patients with acute migraine in the emergency department than the more commonly used opioid treatment option, according to the results of a recent study.

Intravenous (IV) hydromorphone is commonly used for the treatment of migraines in the emergency department, but the effectiveness of a non-opioid option, IV prochlorperazine plus diphenhydramine, is not well established.
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For their study, researchers included 127 patients from 2 emergency departments in New York City. All patients had not used an opioid within the past month, and were randomly assigned to receive either hydromorphone 1 mg or prochlorperazine 10 mg plus diphenhydramine 25 mg, with diphenhydramine administered to prevent akathisia.

The primary outcome was sustained headache relief occurring within 2 hours of administration and maintained for 48 hours.

Overall, the primary outcome was achieved in the prochlorperazine arm by 37 (60%) participants and in the hydromorphone arm by 20 (31%) participants.

“IV hydromorphone is substantially less effective than IV prochlorperazine for the treatment of acute migraine in the ED and should not be used as first-line therapy,” the researchers concluded.

—Michael Potts

Reference:

Friedman BW, Irizarry E, Solorzano C, et al. Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine [published online October 18, 2017]. Neurology. doi: https:/​/​dx.​doi.​org/​10.​1212/​WNL.​0000000000004642.