Prochlorperazine/Diphenhydramine Outperforms Ketamine/Ondansetron for Benign Headache Treatment in the ED

Prochlorperazine is a standard agent with well-described effectiveness for treatment of primary headache disorders in the emergency department (ED). Meanwhile, subdissociative-dose ketamine is coming into wide use for a variety of painful conditions. In a double-blind, randomized trial, investigators compared efficacy of prochlorperazine (10 mg) plus diphenhydramine (25 mg) versus ketamine (0.3 mg/kg) plus ondansetron (4 mg) in a convenience sample of 54 adult ED patients with benign headaches. All medications were given by intravenous push.

The main outcome, reduction in pain on a 100-mm visual analogue scale at 60 minutes, significantly favored prochlorperazine, with a 20-mm greater mean decrease in pain. Most secondary outcomes (e.g., vom…