July 28, 1989

Intravenous Prochlorperazine for Acute Headache

Author Affiliations

Duke University Medical Center Durham, NC

Duke University Medical Center Durham, NC

JAMA. 1989;262(4):502. doi:10.1001/jama.1989.03430040071026

To the Editor.—  In their article, Jones et al1 provide preliminary evidence that intravenous prochlorperazine edisylate treatment offers prompt relief to patients presenting emergently with severe headache. They conclude that use of prochlorperazine "will allow successful treatment of the majority of headache sufferers in the outpatient setting" and suggest that alternate routes of administration be investigated.In recommending broad application of prochlorperazine therapy to outpatients who present with headache, Jones et al understate the potential risks of extrapyramidal dysfunction, tardive dyskinesia, and neuroleptic malignant syndrome. Although dystonic reactions were infrequent among the 42 study patients who received prochlorperazine, dystonia as well as transient dyskinesias have been associated repeatedly with this piperazine phenothiazine.2 Tardive dyskinesia is of special concern; it can develop with low doses of phenothiazines used only briefly, and no consistently effective treatment exists. In addition, one cannot reliably identify patients who are likely to develop this