• Tony Zitek, Melanie Gates, Christopher Pitotti, Alexandria Bartlett, Jayme Patel, Aryan Rahbar, Wesley Forred, Joseph S Sontgerath, and Jill M Clark.
• Department of Emergency Medicine, University of Nevada, Reno School of Medicine, Las Vegas, NV; Department of Emergency Medicine, University of Nevada, Las Vegas School of Medicine, Las Vegas, NV; Department of Emergency Medicine, University Medical Center of Southern Nevada, Las Vegas, NV. Electronic address: zitek10@gmail.com.
• Ann Emerg Med. 2018 Mar 1; 71 (3): 369-377.e1.

Study ObjectiveIntravenous subdissociative-dose ketamine has been shown to be effective for pain management, but has not been specifically studied for headaches in the emergency department (ED). For this reason, we designed a study to compare standard treatment (prochlorperazine) with ketamine in patients with benign headaches in the ED.MethodsThis study was a multicenter, double-blind, randomized, controlled trial with a convenience sample of patients presenting to the ED with benign headaches. Patients were randomized to receive either prochlorperazine and diphenhydramine or ketamine and ondansetron. Patients' headache severity was measured on a 100-mm visual analog scale (VAS) at 0, 15, 30, 45, and 60 minutes. Nausea, vomiting, anxiety, and the need for rescue medications were also tracked. Patients were contacted at 24 to 48 hours posttreatment to rate their satisfaction and to determine whether they were still experiencing a headache.ResultsThere were a total of 54 subjects enrolled. Two patients in the ketamine group and one in the prochlorperazine group withdrew because of adverse effects of the medications. In regard to the primary outcome, at 60 minutes, the prochlorperazine group had a mean improvement in VAS pain scores of 63.5 mm compared with 43.5 mm in the ketamine group, corresponding to a between-groups difference of 20.0 mm (95% confidence interval [CI] 2.8 to 37.2 mm) and a P value of .026. At 45 minutes, the prochlorperazine group had a mean improvement in pain scores of 56.1 mm compared with 38.0 mm in the ketamine group, a difference of 18.1 mm (95% CI 1.0 to 35.2 mm). At 24- to 48-hour follow-up, the mean satisfaction score was 8.3 of 10 for prochlorperazine and 4.9 of 10 for ketamine, a difference of 3.4 (95% CI 1.2 to 5.6). There was not a statistically significant difference in the percentage of patients who had a headache at follow-up or in other secondary outcomes.ConclusionProchlorperazine appears to be superior to ketamine for the treatment of benign headaches in the ED.Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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