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Three Part Question

In [children and adolescents with known migraine] is [chlorpromazine effective] at [resolving symptoms]?

Clinical Scenario

A 12 year old girl presents to the Emergency Department with a one hour history of a severe throbbing headache and an episode of nausea and vomiting 20 minutes previously. She is a known migraine sufferer, and her last episode was one week ago. After history and clinical examination, a diagnosis of migraine is made. You wonder whether Chlorpromazine would be effective in relieving her symptoms.

Search Strategy

Medline 1950-July 2010 using Ovid interface
EMBASE 1980-July 2010 using Ovid interface
Cochrane Database of Systematic Reviews (July 2010)
Medline
[(Exp migraine disorders OR exp Headache OR exp Primary Headache Disorders OR exp Headache Disorders) AND (exp Chlorpromazine) AND (LIMIT to English language AND Humans) AND (LMIT to “All Child (0-18 years)”)]
EMBASE
[(Exp migraine aura OR exp migraine without aura OR exp migraine with aura OR exp migraine OR exp headache OR exp primary headache) AND (exp chlorpromazine) AND (LIMIT to (Human and English Language)) AND (LIMIT to (child OR preschool child <1 to 6 years> OR school child <7 to 12 years> OR adolescent <13 to 17 years>)
Cochrane Database of Systematic Reviews (July 2010)
Search’migraine’ (ti,ab,kw)

Search Outcome

4 papers found in Medline, none were relevan
45 papers found in EMBASE, none were relevant
98 papers found in Cochrane, 1 was relevant

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
L. Billinghurst et al 2009; awaiting review Canada	currently under construction	Intervention Protocol for a review	Objective;To describe and assess the evidence from controlled trials on the efficacy and tolerability of pharmacological interventions by any route of administration versus placebo or other drug treatments for acute attacks of migraine in children	n/a	Results are currently unavailable, but eventually may be relevant to clinical question.

Comment(s)

Chlorpromazine belongs to the class of phenothiazines. It is has been used as a typical antipsychotic, but may have beneficial properties for the treatment of migraines as well as possibly having an antiemetic effect. There are currently no quality trials or studies for the use of Chlorpromazine for migraine attacks in children or adolescents. It is evident that there is a clinical need for more research into its use and effects for this population.

Clinical Bottom Line

No conclusions can be made as to whether Chlorpromazine is effective in treatment of migraine in children and adolescents.

References

1. L. Billinghurst, L. Richer, KF Russell et al Drugs for treating acute migraine headaches in children and adolescents (protocol) The Cochrane Collaboration 2009; Issue 1:1-9