Department of Emergency Medicine, Diabetes Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Neurology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Headache. 2019 May;59(5):682-700. doi: 10.1111/head.13527. Epub 2019 Apr 16.
The aim of this review was to evaluate the efficacy and safety of prochlorperazine (PCP) in patients with acute migraine headache in the emergency department (ED).
Electronic databases (Medline, Scopus, Web of Science, and Cochrane) were searched for randomized clinical trials that investigated the effect of PCP on headache relief. The outcomes were the number of patients without headache or with reduced headache severity, the number of adverse events, and the need for rescue analgesia.
From 450 citations, 11 studies (n = 771) with 15 comparison arms met the inclusion criteria. Overall, PCP was more effective than placebo (OR = 7.23; 95% CI = 3.82-3.68), metoclopramide (OR = 2.89; 95% CI = 1.42-5.86), and other active comparators (OR = 3.70; 95% CI = 2.41-5.67) for headache relief. The odds ratio of experiencing adverse events with PCP compared with placebo was 5.79 (95% CI = 2.43-13.79). When PCP compared with other active comparators, no statistical difference was found regarding the overall number of adverse events (OR = 1.88; 95% CI = 0.99-3.59). However, PCP significantly increased the odds of akathisia/dystonia (OR = 2.55; 95% CI = 1.03-6.31). The request for rescue analgesia was significantly lower in the PCP group compared with other groups (16% vs 84%; OR = 0.16; 95% CI = 0.09-27).
For adult patients with acute migraine, PCP could effectively abort the acute attack and reduce the request for rescue analgesia in the ED. However, compared with placebo, PCP could increase the risk of adverse events.
本综述旨在评估盐酸普罗氯嗪（PCP）在急诊科（ED）急性偏头痛患者中的疗效和安全性。
检索电子数据库（Medline、Scopus、Web of Science 和 Cochrane），以寻找评估 PCP 对头痛缓解效果的随机临床试验。主要结局为无头痛或头痛减轻患者的数量、不良事件的数量和需要使用解救性镇痛药物的情况。
从 450 篇引文中共纳入 11 项研究（n=771）的 15 个比较组。总体而言，PCP 比安慰剂（OR=7.23；95%CI=3.82-3.68）、甲氧氯普胺（OR=2.89；95%CI=1.42-5.86）和其他活性对照药物（OR=3.70；95%CI=2.41-5.67）更能有效缓解头痛。与安慰剂相比，PCP 发生不良事件的比值比为 5.79（95%CI=2.43-13.79）。与其他活性对照药物相比，PCP 组与不良事件总体数量的比值比无统计学差异（OR=1.88；95%CI=0.99-3.59）。然而，PCP 显著增加了静坐不能/运动障碍的几率（OR=2.55；95%CI=1.03-6.31）。与其他组相比，PCP 组需要使用解救性镇痛药物的比例明显更低（16%比 84%；OR=0.16；95%CI=0.09-27）。
对于急性偏头痛的成年患者，PCP 可有效终止急性发作并减少 ED 中对解救性镇痛药物的需求。然而，与安慰剂相比，PCP 会增加不良事件的风险。
