The opioid hydromorphone is used commonly in the emergency department to treat patients with acute migraines, but a more effective treatment is a combination of a dopamine agonist and antihistamine like Benadryl, according to a study published in the journal Neurology.
A randomized, double-blind study conducted by Benjamin W. Friedman, MD, of Albert Einstein College of Medicine in New York City, and colleagues, found that a single intravenous dose of prochlorperazine (known by the brand name Compazine) plus diphenhydramine (the active ingredient in Benadryl) was 28 percent more effective than a single dose of intravenous hydromorphone for achieving 48 hours of headache relief without the need for rescue medication.
As part of the study, patients were randomized to receive the combination drug administered over five minutes or hydromorphone over five minutes plus a normal saline placebo. Sustained headache relief was defined as having a pain level of mild or none within two hours of receiving the treatment and no relapse for 48 hours.
An hour after receiving the initial medication infusion, patients were offered a second dose of the same medication. Thirty-one percent of the hydromorphone group asked for a second dose compared with 8 percent of the combination drug group. Patients who received the opioid were also more likely to request other pain medication – 36 percent compared to 6 percent among the combination drug group.
In June 2017, with 127 participants enrolled, the study was halted because of “overwhelming superiority” of results.
Hydromorphone is most commonly used in emergency departments to treat migraines, though some experts warn against it because there is little evidence it works. The American Headache Society said that there were no randomized studies of the drug for the treatment of acute migraines.
Hydromorphone is an opioid known by the brand names Dilaudid or Exalgo ER. The overprescribing and inappropriate use of opioids have been blamed for the national opioid epidemic, which has killed thousands of Americans in recent years as prescriptions for the potent narcotics have increased.
In late October, President Trump directed the Department of Health and Human Services to declare the opioid crisis a public health emergency, falling short of declaring it a national emergency, which would have enabled the rapid allocation of federal funding to address the issue.