The National Institute for Clinical Studies
(NICS) has published evidence-based guidelines for
the treatment of migraine in Australia.3 They recommend
parenteral phenothiazines (chlorpromazine,
prochlorperazine) or sumatriptan for patients with
moderate to severe symptoms. It also strongly discourages
use of opiates, in particular pethidine (meperidine).
Despite this recommendation, uptake of
phenothiazines as first line treatment has been only
moderate (NICS, unpublished data). A possible
explanation is that physicians are not convinced of
their efficacy. Clinical trials of phenothiazines to date
have been small, and some have had conflicting
results.We performed a systematic review and metaanalysis
to determine the relative efficacy of phenothiazines
compared with placebo and other active
agents for the treatment of acute migraine.