Repetitive intravenous prochlorperazine treatment of patients with refractory chronic daily headache

Objectives.-To investigate the efficacy and long-term outcome of intravenou s prochlorperazine for the treatment of refractory chronic daily headache. Background.-Unlike dihydroergotamine, the treatment results of intravenous neuroleptics as first-line agents for refractory chronic daily headache hav e rarely been reported. Methods.-We retrospectively analyzed the data of inpatients with refractory chronic daily headache who received intravenous repetitive prochlorperazin e treatment from November 1996 to March 1999. A semistructured telephone fo llow-up interview was done in September 1999. Results-A total of 135 patients (44 men, 91 women) were recruited, includin g 95 (70%),vith analgesic overuse. After intravenous prochlorperazine treat ment, 121 (90%) achieved a 50% or greater reduction of headache intensity, including 85 (63%) who became headache-free. The mean hospital stay was 6.2 +/- 2.7 days, and mean total prochlorperazine used was 98 +/- 48 mg. Acute extrapyramidal symptoms occurred in 21 patients (16%). One hundred twenty- four patients (92%) were successfully followed up, with a mean duration of 14.3 +/- 7.5 months. Compared,vith pretreatment status, 93 patients (75%) c onsidered their headache intensity decreased, and 86 patients (63%) conside red their headache frequency decreased, although 40 (32%) still had a daily headache. Of the 87 patients with analgesic overuse who could be followed, 61 (70%) no longer overused analgesics. Poor response to prochlorperazine treatment (relative risk, 1.8) and presence of major depression (relative r isk, 1.8) were predictors of persistent chronic daily headache at follow-up . Conclusions.-Prochlorperazine was effective and safe in the treatment of pa tients with refractory chronic daily headache with or without analgesic ove ruse. Compared with dihydroergotamine, prochlorperazine seemed less effecti ve at achieving "freedom from headache" during hospitalization, but had a s imilar outcome at follow-up.