This single centre study out of the ED at Austin Health, enrolled patients with migraine to either 12.mg IV chlorpromazine (Largactil/Thorazine) vs 12.5mg IV prochorperazine (Stemetil/Compazine).
The primary
outcome was a reduction in pain at 60 minutes as reported on a 11 point
(0-10) Numerical Rating Scale (NRS). They also recorded some secondary
outcomes and safety measures.
Results?
65
patients were
included.
It doesn't
take a statistical genius to understand this study was only powered to find a large
treatment difference. So, it is no surprise they didn’t find one in the
primary nor secondary outcomes.
The only
statistical difference noted was side effects. Chlorpromazine had worse
hypotension and syncope.
What does
this study add to
our knowledge?
Not much.
It was an
elegant study design but woefully underpowered to adequately answer the study
question. It makes me wonder why they bothered. Such small numbers can only
find huge differences (which rarely exist in medicine) and often cannot get rid
of baseline difference in study population and confounding; precisely the
reason for conducting a randomized trial.
Covering:
Hodgson SE,
Harding AM, Bourke EM, et al. A prospective, randomized, double-blind trial of
intravenous chlorpromazine for the treatment of acute migraine in adults
presenting to the emergency department. Headache. 2021;61:603-11. [link to article]
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