My head is killing me…

migraineHeadache is a common presenting symptom to the primary care office.  When accompanied by nausea or photophobia the headache is classified as a migraine.  For acute migrane abortion, I have used any antinausea medication — usually promethazine.  This is a habit I will soon break.  Last month Journal of Emergency Medicine reported a randomized control trial of prochlorperazine vs promethazine.  The results are convincing — prochlorperazine just blows promethazine out of the water (69% to 39%). It also had less sedating (H1) effect and then next day people felt less groggy.  Now the knock in prochlorperazine in the past was akathisia.  However if you remember your physiology, when your patient shows up with a bit of a parkinsonian-like tremor — just add a little (H1 blocker) like Benadryl.  It can even be oral.  But don’t take my word for it…look at the analysis yourself.

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