Can prochlorperazine (Prolomet) be used to treat migraine?

Prochlorperazine (Prolomet) for Migraine Treatment

Yes, prochlorperazine (Compazine/Prolomet) is effective for treating migraine and is recommended as an adjunctive therapy with high efficacy for migraine relief. 1

Efficacy and Evidence

• Prochlorperazine has been shown to effectively relieve headache pain in migraine attacks, with the American Academy of Family Physicians giving it a high efficacy rating of 4 out of 4 for migraine treatment 1
• Prochlorperazine is primarily used as an adjunctive therapy to treat both the associated symptoms of migraine (particularly nausea) and to provide synergistic analgesia 2
• In clinical trials, prochlorperazine has demonstrated superior or equivalent efficacy to many other migraine treatments, including triptans and NSAIDs 3

Dosage and Administration

• The recommended dosage for prochlorperazine in migraine treatment is 25 mg orally, with a maximum of three doses per 24 hours 1
• For patients with significant nausea or vomiting, non-oral routes of administration such as rectal suppositories can be used 1, 4
• Combining prochlorperazine with diphenhydramine (Benadryl) is recommended to prevent extrapyramidal side effects 1

Treatment Algorithm

1. First-line treatment for mild to moderate migraines:

   • NSAIDs such as aspirin (650-1000 mg), ibuprofen (400-800 mg), or naproxen sodium (275-550 mg) 1, 5

2. Second-line treatment for moderate to severe migraines or if NSAIDs are ineffective:

   • Prochlorperazine (25 mg) with diphenhydramine to prevent side effects 1

3. Third-line treatment for migraines unresponsive to above treatments:

   • Triptans or DHE if not contraindicated 1

Contraindications and Precautions

• Prochlorperazine is contraindicated in patients with CNS depression or those using adrenergic blockers 1
• Common adverse effects include hypotension, tachycardia, arrhythmias, akathisia, pseudo-parkinsonism, tardive dyskinesia, and dystonia 1
• The risk of extrapyramidal symptoms can be reduced by co-administering diphenhydramine 1, 6

Clinical Pearls

• Administer prochlorperazine as early as possible in the headache phase for maximum effectiveness 1
• When nausea is a prominent symptom of migraine, prochlorperazine offers dual benefits by treating both the headache pain and the nausea 5
• In comparative studies, prochlorperazine has shown similar or better efficacy compared to metoclopramide for migraine relief 6
• Rectal prochlorperazine (25 mg) has demonstrated excellent pain relief within 2 hours for acute migraine with no significant adverse reactions 4

Monitoring and Follow-up

• Assess treatment response after each attack, documenting frequency, severity, and duration 1
• Consider preventive therapy if attacks occur frequently (two or more attacks per month) or are severe 1
• Monitor for extrapyramidal symptoms, even with diphenhydramine co-administration 1
• If treatment fails, reevaluate diagnosis and consider alternative therapies or specialist referral 1

Prochlorperazine represents an effective option for migraine treatment, particularly when nausea is present or when first-line treatments have failed. Its dual action on both pain and nausea makes it particularly valuable in the migraine treatment armamentarium.