Skip Opioid Therapy for Migraine within the ER

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By Mary Elizabeth Dallas

HealthDay Reporter

WEDNESDAY, Oct. 18, 2017 (HealthDay Information) — For individuals looking for remedy for a migraine within the emergency room, a generally prescribed opioid known as hydromorphone (Dilaudid or Exalgo) would not appear to work in addition to at the least one different treatment, a brand new research finds.

“Individuals go to U.S. emergency departments 1.2 million occasions a yr with migraine, and the opioid drug hydromorphone is utilized in 25 p.c of those visits, but there have been no randomized, high-quality research on its use for acute migraine,” mentioned research writer Dr. Benjamin Friedman. He’s with the division of emergency medication on the Albert Einstein School of Medication in New York Metropolis.

Docs ought to take into account out there options earlier than giving sufferers the opioid painkiller, the research authors urged in a information launch from the American Academy of Neurology.

For the research, researchers investigated if opioid use led to dependancy amongst 127 sufferers who made repeated journeys to 2 emergency departments in New York for remedy of migraines.

Half of the individuals have been handled with hydromorphone. The remaining sufferers got prochlorperazine via an IV. This drug works by blocking the discharge of a mind chemical known as dopamine.

The researchers checked out how lots of the sufferers had migraine reduction for at the least 48 hours. The research was halted after the 127 sufferers have been enrolled as a result of the outcomes confirmed that prochlorperazine labored dramatically higher than hydromorphone.

After 48 hours, 60 p.c of the sufferers on prochlorperazine had extended headache reduction, in contrast with 31 p.c of the individuals handled with hydromorphone. Within the emergency room, 31 p.c of those that obtained hydromorphone requested for a second dose of the drug. The identical was true for less than eight p.c of those that obtained prochlorperazine.

Of the sufferers on hydromorphone, 36 p.c requested for different painkillers, in contrast with solely 6 p.c of the prochlorperazine group, based on the report.

There was no distinction in how usually the sufferers from each remedy teams returned to the ER as a result of a migraine inside one month of the remedy, the researchers identified.

Continued

Friedman famous that sufferers who had used opioids inside the previous 30 days or had a historical past of dependancy to those medicine have been excluded from the research. Subsequently, the research contributors might have been at decrease danger for an opioid abuse downside than individuals within the normal inhabitants.

“Whereas this research demonstrates the overwhelming superiority of prochlorperazine over hydromorphone for preliminary remedy of acute migraine, the outcomes don’t recommend that remedy with IV opioids results in long-term dependancy,” Friedman mentioned.

“As well as, the outcomes shouldn’t be used to keep away from the usage of opioids for individuals who haven’t responded nicely to anti-dopaminergic medicine [such as prochlorperazine],” he added.

The research was printed on-line Oct. 18 within the journal Neurology.

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