Benadryl as an Adjuvant in Migraine Treatment?

Acute migraine is best treated with sumatriptan, prochlorperazine, caffeine, ibuprofen, or a combination, and opioids should be avoided assiduously. Metoclopramide is often used instead of prochlorperazine, though it is probably inferior (NEJM JW Psychiatry Jan 1996 and Ann Emerg Med 1995; 26:541). Both metoclopramide and prochlorperazine cause extrapyramidal side effects, most commonly akathisia. Because these side effects are treated with diphenhydramine, many clinicians administer a small dose of diphenhydramine whenever they administer these medications.

To assess the effect of this practice, researchers randomized 208 patients younger than 65 years with migraine to treatment with 10 mg metoclopramide plus either 50 mg diphenhydramine or…