Efficacy of Haloperidol vs. Metoclopramide for Treatment of Acute Headaches and Migraines in the Emergency Department
| Status: | Terminated |
|---|---|
| Conditions: | Migraine Headaches, Migraine Headaches, Hospital |
| Therapuetic Areas: | Neurology, Other |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 10/25/2018 |
| Start Date: | February 2014 |
| End Date: | April 24, 2017 |
Investigating the Efficacy of Using Haloperidol vs. Metoclopramide for Treatment of Acute Headaches and Migraines in the Emergency Department: A Prospective Randomized Clinical Trial
Metoclopramide (Reglan) is a common agent used for relief of headaches in the emergency
department (ED).In this study the investigators seek to explore another option for treatment
of headaches in the ED, one that may be more efficacious and efficient. Haloperidol (Haldol),
a butyrophenone class of medication, is thought to act by affecting the dopamine 2 receptor
in the brain.
By exploring haloperidol as an option for treatment, the investigators hope to discover a
more efficient and effective medication for the treatment of non-traumatic headaches, thereby
decreasing a patient's length of stay in the department and decreasing the rate of return
visits for continued discomfort from the same headache. This study could lead to the
increased usage of haloperidol as a first line agent in the treatment of prolonged headaches
presenting to the ED.
department (ED).In this study the investigators seek to explore another option for treatment
of headaches in the ED, one that may be more efficacious and efficient. Haloperidol (Haldol),
a butyrophenone class of medication, is thought to act by affecting the dopamine 2 receptor
in the brain.
By exploring haloperidol as an option for treatment, the investigators hope to discover a
more efficient and effective medication for the treatment of non-traumatic headaches, thereby
decreasing a patient's length of stay in the department and decreasing the rate of return
visits for continued discomfort from the same headache. This study could lead to the
increased usage of haloperidol as a first line agent in the treatment of prolonged headaches
presenting to the ED.
At this time, choice of medications for the treatment of headaches in the ED is still based
on personal and patient preferences because no properly constructed trials have been carried
out that would allow identification of a superior agent. Metoclopramide (Reglan) is a common
agent used for relief of headaches in the ED. Uncontrolled studies have shown successful
relief of migraine with metoclopramide of 75%. Further studies have reported success rate of
67% with IV metoclopramide. In this study the investigators seek to explore another option
for treatment of headaches in the ED, one that may be more efficacious and efficient.
Haloperidol (Haldol), a butyrophenone class of medication, is thought to act by affecting the
dopamine 2 receptor in the brain. These receptors are relatively abundant in the brainstem
nuclei and sympathetic ganglia and nerves, through which they may regulate autonomic
visceral, gastrointestinal, and hemodynamic responses frequently associated with migraine.
One study, demonstrated that 4 out of 5 patients felt significant relief in pain intensity
with the use of haloperidol, even when other medications had failed. Relapses were rare, and
several patients reported that haloperidol interrupted the prolonged, intractable migraine
spiral they had suffered for days. Furthermore, a case series of six cases of migraine
treated with 5mg of haloperidol IV after a 500 to 1000ml bolus of IV fluids reported complete
or substantial relief within 25 to 65 minutes and side effects were reported as minimal.
The investigators hypothesize that Haloperidol is more efficacious than metoclopramide in the
treatment of an acute headache or migraine in the ED in regard to a self-reported pain rating
scale (Numeric Pain Intensity Scale), need for additional medication, emergency department
return rates, and resolution of symptoms.
on personal and patient preferences because no properly constructed trials have been carried
out that would allow identification of a superior agent. Metoclopramide (Reglan) is a common
agent used for relief of headaches in the ED. Uncontrolled studies have shown successful
relief of migraine with metoclopramide of 75%. Further studies have reported success rate of
67% with IV metoclopramide. In this study the investigators seek to explore another option
for treatment of headaches in the ED, one that may be more efficacious and efficient.
Haloperidol (Haldol), a butyrophenone class of medication, is thought to act by affecting the
dopamine 2 receptor in the brain. These receptors are relatively abundant in the brainstem
nuclei and sympathetic ganglia and nerves, through which they may regulate autonomic
visceral, gastrointestinal, and hemodynamic responses frequently associated with migraine.
One study, demonstrated that 4 out of 5 patients felt significant relief in pain intensity
with the use of haloperidol, even when other medications had failed. Relapses were rare, and
several patients reported that haloperidol interrupted the prolonged, intractable migraine
spiral they had suffered for days. Furthermore, a case series of six cases of migraine
treated with 5mg of haloperidol IV after a 500 to 1000ml bolus of IV fluids reported complete
or substantial relief within 25 to 65 minutes and side effects were reported as minimal.
The investigators hypothesize that Haloperidol is more efficacious than metoclopramide in the
treatment of an acute headache or migraine in the ED in regard to a self-reported pain rating
scale (Numeric Pain Intensity Scale), need for additional medication, emergency department
return rates, and resolution of symptoms.
Inclusion Criteria:
- Patients who present with a headache or migraine with onset less than or equal to 72
hours
Exclusion Criteria:
- Known pregnancy
- Breast-feeding women
- Known history of arrhythmias or QT prolongation (450 ms)
- Known adverse effects to haloperidol, diphenhydramine (Benadryl) or metoclopramide
- Subarachnoid hemorrhage
- Headaches caused by trauma, meningitis
- Congestive heart failure
- Parkinson's Disease
- Dementia
- Pheochromocytoma
- History of glaucoma
- History of seizures
- Non-English speaking patients
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