Non-opioid treatment more effective for migraine at emergency room

THURSDAY, Oct. 19, 2017 -- For people seeking treatment for a migraine in the emergency room, a commonly prescribed opioid called hydromorphone, such as Dilaudid or Exalgo, doesn't seem to work as well as at least one other medication, a new study finds.

"People go to U.S. emergency departments 1.2 million times a year with migraine, and the opioid drug hydromorphone is used in 25 percent of these visits, yet there have been no randomized, high-quality studies on its use for acute migraine," said study author Dr. Benjamin Friedman. He is with the department of emergency medicine at the Albert Einstein College of Medicine in New York City.

Doctors should consider available alternatives before giving patients the opioid painkiller, the study authors suggested in a news release from the American Academy of Neurology.

For the study, researchers investigated if opioid use led to addiction among 127 patients who made repeated trips to two emergency departments in New York for treatment of migraines.

Half of the people were treated with hydromorphone. The remaining patients were given prochlorperazine through an IV. This drug works by blocking the release of a brain chemical called dopamine.

The researchers looked at how many of the patients had migraine relief for at least 48 hours. The study was halted after the 127 patients were enrolled because the results showed that prochlorperazine worked dramatically better than hydromorphone.

After 48 hours, 60 percent of the patients on prochlorperazine had prolonged headache relief, compared with 31 percent of the people treated with hydromorphone. In the emergency room, 31 percent of those who received hydromorphone asked for a second dose of the drug. The same was true for only 8 percent of those who received prochlorperazine.

Of the patients on hydromorphone, 36 percent asked for other painkillers, compared with only 6 percent of the prochlorperazine group, according to the report.

There was no difference in how often the patients from both treatment groups returned to the ER due to a migraine within one month of the treatment, the researchers pointed out.

Friedman noted that patients who had used opioids within the past 30 days or had a history of addiction to these drugs were excluded from the study. Therefore, the study participants may have been at lower risk for an opioid abuse problem than people in the general population.

"While this study demonstrates the overwhelming superiority of prochlorperazine over hydromorphone for initial treatment of acute migraine, the results do not suggest that treatment with IV opioids leads to long-term addiction," Friedman said.

"In addition, the results should not be used to avoid the use of opioids for people who have not responded well to anti-dopaminergic drugs [such as prochlorperazine]," he added.

The study was published online Oct. 18 in the journal Neurology.

More information

The U.S. National Library of Medicine has more about the opioid hydromorphone.