Efficacy of intravenous diphenhydramine versus intravenous DHE-45 in the treatment of severe migraine headache

This study was conducted to compare the efficacy of intravenous diphenhydramine with dihydroergotamine mesylate (DHE-45; Novartis International AG, Switzerland) in the treatment of severe, refractory, migraine headache. A retrospective review was conducted to include eighty randomly chosen patients who were admitted to the Michigan Head Pain & Neurological Institute's inpatient program at Chelsea Community Hospital. Patients had received nine doses of diphenhydramine or nine doses of DHE-45 during a 3-day period. Patients receiving DHE-45 also received metoclopramide (Reglan; AH Robins Company, Inc., Richmond, VA) as prophylaxis for nausea. Demographics, headache diagnosis, psychiatric discharge diagnoses, abortive medications, and adverse events were recorded and assessed. Copyright © 2005 by Current Science Inc.; Indications:40 patients with intractable migraine headaches. Concomitant diseases: depressive disorders (26), personality disorders (18), anxiety disorders (17), bipolar disorders (2), addictive disorders (5), and others (34).; Patients:80 inpatients, 25 male and 55 female, aged 16 to 73 years, were studied. Dihydergot group: 40 patients, 13 male and 27 female, mean age 38 years. Diphenhydramine group: 40 patients, 12 male and 28 female, mean age 46 years.; TypeofStudy:This study compared the efficacy of iv Dihydergot to iv diphenhydramine in the treatment of hospitalized patients with intractable migraine headaches. Retrospective randomized study.; DosageDuration:0.25-1.0 mg iv tid (=0.75-3.0 mg daily); average dose of 0.79 ± 0.18 mg. Maximum dose was 1 mg then tapered down after nine doses. Duration: 3 days.; ComparativeDrug:Diphenhydramine (Benadryl): 25-75 mg iv tid (=75-225 mg daily, nine doses); 41.08 ± 13.85 mg. Duration: 3 days.; FreeText:The primary efficacy variable was reduction in head pain level on a 6- point scale (0 = no head pain to 5 = most intense and disabling pain) following administration of each dose compared with pre-administration of the medication. Secondary measures such as patient demographics, adverse effects, and rescue medications used were compared between the groups. Rescue medication for headache relief included hydroxyzine, ketorolac and perphenazine. In the Dihydergot group, patients were pretreated with metoclopramide 10 mg to 15 mg orally or iv about 30 minutes prior to each Dihydergot dose as needed for nausea prophylaxis). Other antiemetics used were ondansetron and trimethobenzamide.; AuthorsConclusions:Intravenously administered diphenhydramine may be an effective agent in the treatment of some cases of intractable chronic migraine and it may be used in conjunction with DHE-45 [dihydroergotamine mesilate] or other parenteral medications for cases that are difficult to manage. If confirmed by further study, diphenhydramine would provide an alternative for patients who have contraindications, cannot tolerate, or do not benefit from other available agents including DHE-45. The population studied in this project were referred to a tertiary, comprehensive headache center and are among the most treatment-refractory patients. The results of this study support further investigation of the use of diphenhydramine in patients with various manifestations of migraine.; Results:Diphenhydramine was more efficacious in decreasing head pain levels with each dose when the pre- and post-treatment head pain levels were compared with those of Dihydergot (p=0.0004). Patients in the diphenhydramine group reported significant reduction in the mean head pain scores in six of nine drug treatments compared with those patients in the Dihydergot. The Dihydergot group showed a significant reduction in mean head pain scores in only one of nine doses. However, Dihydergot showed greater reduction when baseline head pain levels were compared with head pain levels at the end of the 3-day protocol. In the Dihydergot group, the average headache level decreased from 3.03 ± 1.21 to 1.56 ± 1.37 from baseline to the completion of the protocol. In the diphenhydramine group, the average headache level decreased from 3.10 ± 1.20 to 2.39 ± 1.51. These findings suggest that diphenhydramine may be more efficacious in the immediate, short-term reduction of head pain levels after each treatment, whereas Dihydergot had a stronger and perhaps accumulative value in reducing head pain levels over the full course of treatment. The most common side effects were nausea (40%) in the Dihydergot group and drowsiness/sedation in the diphenhydramine group. Cognitive dysfunction of varying degree was more common in the diphenhydramine group. There were no serious side effects in either group.; AdverseEffects:16 patients had nausea, and unspecified number of patients had cognitive dysfunction and other side effects.