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Unfortunately, despite extensive evidence specifically demonstrating lack of efficacy, parenteral opioids are commonly used to treat migraine headaches in the emergency department (ED). In a randomized double-blind trial, researchers compared the efficacy of intravenous hydromorphone (1 mg) versus IV prochlorperazine (10 mg) plus diphenhydramine (25 mg) in 127 adults with a diagnosis of migraine and no recent opioid use. Eligible patients presented to two New York City EDs with moderate to severe headache pain.
Patients were offered a second dose of medication 1 hour after the first. Symptoms were assessed on a 4-item headache pain scale (severe, moderate, mild, none) in the ED every hour for up to 4 hours, and by phone call at 48 hours. The…