Parenteral Hydromorphone for Migraine and ED Revisits

Hydromorphone-related "likeability" and "feeling good" may not be associated with return visits to the emergency department in patients treated with the drug for migraine.

Hydromorphone-related ”likeability” and “feeling good” may not be associated with return visits to the emergency department (ED) in patients treated with the drug for migraine, according to a study published in Headache.

To determine the extent to which the nontherapeutic effects of opioids influence migraine outcomes, researchers conducted an ED-based clinical trial, in which 127 patients (mean age 34) with moderate or severe acute migraine were randomly assigned to receive hydromorphone (1 mg intravenously) or prochlorperazine (10 mg) plus diphenhydramine (25 mg).

Thirty minutes after receiving medication, the level of euphoria was evaluated by asking patients, ”How much did you like the medication you received?” and “How good did the medication make you feel?” In addition, patients were asked to report their level of pain before and after treatment. Likeability and pain level were reported using a 0 to 10 scale.

“Likeability” was rated at a mean of 7.2 and 6.9 by patients who received prochlorperazine and hydromorphone, respectively. Pain scores increased by 6.8 points for patients who received prochlorperazine, and by 4.7 points for those in the hydromorphone group. Eight of 57 patients (14.0%) who received hydromorphone returned to the ED within 1 month for further dosage compared with 5 of 63 patients (7.9%) who received prochlorperazine.

Using regression modeling, researchers determined that “feeling good” and “medication likeability” were independently associated with pain relief (P <.01 for both) but not with medication received (P =.67 and P =.12, respectively) or return visits (P =.12 and P =.16, respectively).

Researchers noted several limitations to their study. The questions used to assess euphoria may not have captured the true experience of the feeling accurately. Additionally, the dosage of hydromorphone administered, while based on typical practice, might have not elicited the euphoria and pain relief of higher doses.

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Despite these limitations, researchers concluded, “These data suggest that opioid-induced euphoria may not be the primary driver of return visits to an ED for management of acute migraine. Migraine patients appear to value medications that afford them relief of pain rather than opioid-induced euphoria.”

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Friedman BW, Latev A, Campbell C, White D. Opioid-induced “likeability” and “feeling good” are not associated with return visits to an ED among migraine patients administered IV hydromorphone [published online March 8, 2018]. Headache. doi: 10.1111/head.13292