HALDOL ET MIGRAINE

HALDOL ET MIGRAINE
QUESTION : Est ce que le Haldol avec cette dose est si efficace pour le traitement de
migraine aiguë résistante sans effet secondaire ?
AUTEURE :
Nancy Guirguis (JANVIER 2009)
SUPERVISEURE : Guylène Thériault
CONTEXTE :
Durant mon stage d'urgence, un urgentologue m'a suggéré de traiter les cas aigus de
migraine, résistantes aux autres modèles de traitement avec 10 mg IM d'Haldol. En
appuyant sur son effet miraculeux durant 10 ans d'essai. J'étais un peu hésitante à
cause de la grande dose et la probabilité d’effet secondaire.
RECHERCHE
Cochrane :
0 étude
Pub Med : 1 étude Randomize contrôlée de 2006, :Haldol in the acute treatment of
migraine.
Clinical evidence:
3 études
1. même étude de Pub med;
2. étude comparative : comparant entre dexamethaone et haloperidol : étude en
espagnol ou portugais;
3. "Case Series" de 1995: a new approach to emergency department therapy of
migraine headache with intravenous haloperidol.
RÉSULTATS
Haloperidol in the acute treatment of migraine: a randomized, double-blind, placebo,
controlled study.
Jari Honkaniemi, MD, PhD; Suvi Liimatainen, MD; Sirpa Rainesalo, MD, PhD; Sari
Sulavuori, MD
From the Departments of Neurology, University of Tampere, and Tampere University
Hospital, Tampere; and Vaasa Central Hospital, Vaasa, Finland
Objective.—To assess the efficacy and safety of IV haloperidol in treatment of acute
migraine headache in a double-blind, randomized, placebo-controlled study design.
Background.—Neuroleptics are mainly used as antiemetic in acute migraine. In a
previous open trial haloperidol was effective in relieving migraine pain.
Design:
Patients were randomized into 2 groups receiving intravenously either 5
mg haloperidol in 500 mL of normal saline or 500 mL of normal saline alone. Pain was
assessed by visual analogue scale (VAS) before and 1 to 3 hours after the infusion. If
the patient felt no relief in pain intensity 1 to 3 hours after the infusion and had received
placebo, he/she then received haloperidol infusion as an open trial. The open trial also
included 7 patients who refused from the placebo-controlled trial. About 1 month after
the infusion the patients were contacted by telephone and interviewed about the side
effects of the treatment.
Results:
Forty patients were enrolled into the double-blind, placebo-controlled
study. Before the infusion the VAS values were 7.7 in the haloperidol and 7.2 in the
placebo group. After the infusion the VAS values were 2.2 in the haloperidol and 6.3 in
the placebo group (P < .0001). Significant pain relief was achieved in 80% of the
patients treated with haloperidol, whereas only 3 patients (15%) responded to placebo
(P < .0001). Seventeen patients treated with placebo without response together with 7
patients who refused from the placebo-controlled study participated in the open trial. In
this group VAS declined from 6.7 to 2.4 and 79% of these patients felt significant pain
relief. The most common side effects caused by haloperidol were sedation and
akathisia, the latter being more troublesome. These effects were very common in
patients participating in the double-blind (80%) and open (88%) trials. Sixteen percent of
the patients considered the side effects intolerable and would not like the migraine
attacks to be treated with haloperidol in the future. Three patients (7%) returned to the
emergency ward because of a relapse.
Conclusions: This study shows that IV haloperidol is very effective in relieving migraineassociated pain. Because the majority of the patients had taken other medication
without response, haloperidol appears to be an effective rescue medication even when
other types of treatment have failed. Relapses are rare, but side effects are common,
limiting the use of haloperidol in some patients
A new approach to emergency department therapy of migraine headache with
intravenous haloperidol: a case series
Mt.Sinai Hospital, Toronto, Canada
Date: 1995
Six case reports are presented that describe the use of the IV haloperidol for patient with
migraine headache. Haloperidol was used in a dose of 5 mg following 500 to 1000 cc
bolus of normal saline. Headache was completely or substantially relieved in all 6 pts 25
to 65 min after administration of haloperidol; the median time until discharge was 51
min. Side effects were minimal or nonexistent. None of the pts returned to ED for any
reason over the next 48 h. It is concluded that haloperidol may play a role in treatment of
migraine headache in the ED, and that further study is warranted.
CONCLUSION
Une étude randomisée récente mais petite qui répond à ma question.
Dans l'étude, on utilisait 5 mg d'Haloperidol, qui démontrait une efficacité de 80 % mais
aussi un grand pourcentage d'effet secondaire.
À mon avis, on pourrait utiliser l'haloperidol à 5 mg iv s'il n'y a pas de contre-indication et
si le patient accepte tout en sachant qu’il existe une possibilité d'effet secondaire.