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Prochlorperazine has been shown to be more effective than metoclopramide for acute migraine, but prochlorperazine is associated with akathisia in about one third of patients (JW Nov 14 1995 and JW Emerg Med Jan 2 2002). In a randomized, double-blind study, researchers compared efficacy and side effects of intravenous prochlorperazine (10 mg) and IV promethazine (25 mg) in patients who presented to a single emergency department with benign headache. Patients with fever, trauma, or neurological deficit or who reported the “worst headache of their lives” were excluded; 70 patients were enrolled. Diphenhydramine (25 mg) was administered for symptoms of dystonia or akathisia.
Thirty minutes after drug administration, significantly more patients i…