Table 46Summary of the strength of evidence for the effectiveness of neuroleptics versus placebo or an active treatment (Key Question 1)

OutcomeComparison (# Studies)Strength of EvidenceSummary
Pain intensity–VASNeuroleptics vs. placebo (4 RCTs)ModerateSignificant effect in favor of neuroleptics
(MD = −46.59; 95% CI: −54.87, −38.32, I2 = 46%)
Headache relief (1 hr)Neuroleptic vs. placebo (5 RCTs)ModerateSignificant effect in favor of neuroleptics
(RR = 2.69, 95% CI: 1.66, 4.34; I2 = 76%)
Pain free (1 hr)Neuroleptic vs. placebo (4 RCTs)ModerateSignificant effect in favor of neuroleptics
(RR = 3.38; 95% CI: 1.16, 9.83; I2 = 90%).
Headache recurrence (24 hrs)Neuroleptic vs. placebo (2 RCTs)LowNo significant difference between groups
(RR = 0.46; 95% CI: 0.19, 1.10; I2 = 78%)
Patient satisfactionNeuroleptics vs. placebo (1 RCT)InsufficientSignificant effect in favor of chlorpromazine
(RR = 3.28; 95% CI: 1.10, 9.82)
Change in pain–VASMetoclopramide vs. neuroleptics (4 RCTs)LowSignificant effect in favor of neuroleptics
(MD = 16.45; 95%CI: 2.08, 30.83; I2 = 81%)
Change in pain–VASMetoclopramide vs. prochlorperazine (2 RCTs)LowNo significant difference between groups
(MD = 19.27; 95% CI: −8.85, 47.38; I2 = 90%)
Headache recurrenceMetoclopramide vs. prochlorperazine (1 RCT)InsufficientNo significant difference between groups
(RR = 0.41; 95% CI: 0.11, 1.51)
Change in pain-–VASProchlorperazine vs. sodium valproate (1 RCT)InsufficientSignificant effect in favor of prochlorperazine
(MD = −55.5; 95% CI: −81.14, −29.86)
Change in pain–VASProchlorperazine vs. MgSO4 (1 RCT)InsufficientSignificant effect in favor of prochlorperazine
(MD = −23.0; 95% CI: −44.67, −1.33)
Change in pain- VASMetoclopramide vs. chlorpromazine (1 RCT)InsufficientSignificant effect in favor of chlorpromazine
(MD = 25.0; 95% CI: 12.14, 37.86)
Change in pain–VASChlorpromazine vs. DHE (1 RCT)InsufficientSignificant effect in favor of chlorpromazine
(MD = −40.0; −47.12, −32.88)
Headache reliefChlorpromazine vs. DHE (1 RCT)InsufficientNo significant difference between groups
(RR = 1.44; 95% CI: 0.59, 3.56)
Change in pain–VASChlorpromazine vs. lidocaine (1 RCT)InsufficientSignificant effect in favor of chlorpromazine
(MD = −27.5; 95% CI: −33.85, −21.15)
Headache reliefChlorpromazine vs. lidocaine (1 RCT)InsufficientSignificant effect in favor of chlorpromazine
(RR = 4.33; 95% CI: 1.02, 18.41)
Change in pain–VASProchlorperazine vs. ketorolac (1 RCT)InsufficientSignificant effect in favor of prochlorperazine
(MD = −19.0; 95% CI: −34.97, −3.03)
Change in pain–VASChlorpromazine hydrochloride vs. ketorolac tropethamine (1 RCT)InsufficientNo significant difference between groups
(MD = −5.30; 95% CI: −24.89, 14.29)
Change in pain–VASDroperidol vs. meperidine (1 RCT)InsufficientNo significant difference between groups
(MD = −10.0; 95% CI: −30.03, 10.03)
Change in pain–VASMethotrimeprazine vs. meperidine + dimenhydrinate (1 RCT)InsufficientNo significant difference between groups
(MD = 6.30; 95% CI: −4.77, 17.37)
Pain intensity–VASMeperidine + dimenhydrinate vs methotrimeprazine (1 RCT)InsufficientNo significant difference between groups
(MD = 15.0; 95% CI: −2.75, 32.75)
Change in pain–VASChlorpromazine vs. meperidine + dimenhydrinate (1 RCT)InsufficientSignificant effect in favor of chlorpromazine
(MD = −26.1; 95% CI: −40.1, −12.1)
Change in pain–VASProchlorperazine + DPH vs. sumatriptan (1 RCT)InsufficientSignificant effect in favor of prochlorperazine
(MD = −23.0; 95% CI: −35.5, −10.5)
Change in pain–VASMetoclopramide + DPH vs. prochlorperazine + DPH (1 RCT)InsufficientNo significant difference between groups
(MD = 3.0; 95% CI: −9.75, 15.75)
Sustained headache reliefProchlorperazine + DPH vs. Metoclopramide + diphnehydramine (1 RCT)InsufficientNo significant difference between groups
(RR = 0.73; 95% CI: 0.48, 1.12)
Pain free (2 hrs)Prochlorperazine + DPH vs. Metoclopramide + DPH (1 RCT)InsufficientNo significant difference between groups
(RR = 0.71; 95% CI: 0.44, 1.16)
Headache relief (2 hrs)Prochlorperazine + DPH vs. Metoclopramide + DPH (1 RCT)InsufficientNo significant difference between groups
(RR = 0.91; 95% CI: 0.73, 1.12)
Change in pain–VASProchlorperazine vs. promethazine (1 RCT)InsufficientNo significant difference between groups
(MD = −19.05; 95% CI: −67.31, 29.21)
Headache recurrenceProchlorperazine vs. promethazine (1 RCT)InsufficientNo significant difference between groups
(RR = 0.71; 95% CI: 0.45, 1.14)
Change in pain–VASProchlorperazine vs. droperidol (2 RCTs)LowNo significant difference between groups
(MD = 9.12; 95% CI: −8.62, 26.86)
Headache reliefProchlorperazine vs. droperidol (2 RCTs)ModerateSignificant effect in favor of droperidol
(RR = 0.81; 95% CI: 0.68, 0.98)
Pain free at 30 mins (1; 95)Prochlorperazine vs. droperidol (1 RCT)InsufficientNo significant difference between groups
(RR = 0.71; 95% CI: 0.45, 1.11)
Change in pain–VASProchlorperazine vs. octreotide (1 RCT)InsufficientSignificant effect in favor of prochlorperazine
(MD = −17.2; 95% CI: −32.13, −2.27)
Headache reliefProchlorperazine vs. octreotide (1 RCT)InsufficientSignificant effect in favor of prochlorperazine
(RR = 1.59; 95% CI: 1.08, 2.34)
Change in pain–VASOlanzapine vs. droperidol (1 RCT)InsufficientNo significant difference between groups
(MD = −6.2; 95% CI: −17.16, 4.76)
Pain free (30 min)Haloperidol vs. dexamethasone (1 RCT)InsufficientNo significant difference between groups
(RR = 2.68; 95% CI: 0.62, 11.64)
Headache recurrenceHaloperidol vs. dexamethasone (1 RCT)InsufficientNo significant difference between groups
(no events in either group)

CI = confidence interval; DHE = dihydroergotamine; DPH = diphenhydramine; MD = mean difference; MgSO4 = magnesium sulfate; RCT = randomized controlled trial; RR = risk ratio; VAS = visual analog scale

From: Summary and Discussion

Cover of Acute Migraine Treatment in Emergency Settings
Acute Migraine Treatment in Emergency Settings [Internet].
Comparative Effectiveness Reviews, No. 84.
Sumamo Schellenberg E, Dryden DM, Pasichnyk D, et al.

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