Recommended Citation
Cirone M, Szwajnos T, Ashrafi S, et al. Evaluating the Effectiveness of Magnesium in Addition to Prochlorperazine for the Treatment of Migraines in the Emergency Department. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Clinical practice guidelines for the acute management of migraines recommend antiemetics such as prochlorperazine as first-line therapy. Although intravenous (IV) magnesium sulfate (Mg) has demonstrated benefit as a standalone treatment for acute migraines, whether it can provide additive analgesic benefit when combined with prochlorperazine is unknown.
Purpose:
Determine whether IV Mg combined with prochlorperazine provides greater reduction than prochlorperazine monotherapy in emergency department (ED) patients with acute migraine.
Methods:
This prospective, double-blind, randomized controlled trial compares IV prochlorperazine and Mg with prochlorperazine and placebo in patients presenting the ED with symptoms of acute migraine. All participants received IV diphenhydramine 25 mg and prochlorperazine 10 mg, with randomization to Mg 2 g or placebo. The primary endpoint was mean change in pain 30 minutes after the initiation of the study drug using an 11-point Numeric Rating Scale. Secondary endpoints included pain reduction at 45 and 60 minutes, time to discharge, and adverse effects. Analysis employed descriptive statistics with Shapiro-Wilk, Chi-square tests, ANOVA, and logistic regression. A power analysis indicated 100 patients, 50 per group, were required to detect a 15% difference in pain reduction between groups at p<0.05 significance.
Results:
As of February 8, 2026, 26 patients were enrolled (n=11 Mg, n=15 placebo). All patients in the Mg group were female versus 11 of 15 in the placebo group. Mean ages were 37 and 49 years, respectively. Migraine history was present in 7 Mg and 6 placebo patients; aura occurred in 3 and 2 patients, respectively. Baseline pain scores averaged 7.2 for Mg and 6.4 for placebo, with 30-minute reductions of 4.6 points (64%) versus 1.3 points (20%); at 45 minutes, 6.0 points (83%) versus 3.3 points (52%); and at 60 minutes, 6.3 points (88%) versus 4.0 points (63%), respectively. Adverse events occurred in 3 Mg patients (flushing, akathisias) and 4 placebo patients (akathisias, dizziness, drowsiness). Rescue medication use was lower in the Mg group (2 vs. 4 patients), and mean ED discharge times were 409 minutes for Mg and 879 minutes for placebo.
Conclusion:
Preliminary findings signal Mg combined with prochlorperazine provides greater efficacy in reducing migraine pain compared to prochlorperazine alone. Full enrollment and analysis are needed to confirm the role of Mg in acute migraine management and its potential to improve outcomes for ED patients.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Oral/Podium Presentation
Evaluating the Effectiveness of Magnesium in Addition to Prochlorperazine for the Treatment of Migraines in the Emergency Department
Background/Significance:
Clinical practice guidelines for the acute management of migraines recommend antiemetics such as prochlorperazine as first-line therapy. Although intravenous (IV) magnesium sulfate (Mg) has demonstrated benefit as a standalone treatment for acute migraines, whether it can provide additive analgesic benefit when combined with prochlorperazine is unknown.
Purpose:
Determine whether IV Mg combined with prochlorperazine provides greater reduction than prochlorperazine monotherapy in emergency department (ED) patients with acute migraine.
Methods:
This prospective, double-blind, randomized controlled trial compares IV prochlorperazine and Mg with prochlorperazine and placebo in patients presenting the ED with symptoms of acute migraine. All participants received IV diphenhydramine 25 mg and prochlorperazine 10 mg, with randomization to Mg 2 g or placebo. The primary endpoint was mean change in pain 30 minutes after the initiation of the study drug using an 11-point Numeric Rating Scale. Secondary endpoints included pain reduction at 45 and 60 minutes, time to discharge, and adverse effects. Analysis employed descriptive statistics with Shapiro-Wilk, Chi-square tests, ANOVA, and logistic regression. A power analysis indicated 100 patients, 50 per group, were required to detect a 15% difference in pain reduction between groups at p<0.05 significance.
Results:
As of February 8, 2026, 26 patients were enrolled (n=11 Mg, n=15 placebo). All patients in the Mg group were female versus 11 of 15 in the placebo group. Mean ages were 37 and 49 years, respectively. Migraine history was present in 7 Mg and 6 placebo patients; aura occurred in 3 and 2 patients, respectively. Baseline pain scores averaged 7.2 for Mg and 6.4 for placebo, with 30-minute reductions of 4.6 points (64%) versus 1.3 points (20%); at 45 minutes, 6.0 points (83%) versus 3.3 points (52%); and at 60 minutes, 6.3 points (88%) versus 4.0 points (63%), respectively. Adverse events occurred in 3 Mg patients (flushing, akathisias) and 4 placebo patients (akathisias, dizziness, drowsiness). Rescue medication use was lower in the Mg group (2 vs. 4 patients), and mean ED discharge times were 409 minutes for Mg and 879 minutes for placebo.
Conclusion:
Preliminary findings signal Mg combined with prochlorperazine provides greater efficacy in reducing migraine pain compared to prochlorperazine alone. Full enrollment and analysis are needed to confirm the role of Mg in acute migraine management and its potential to improve outcomes for ED patients.
Affiliations
Advocate Christ Medical Center, Advocate Good Shepherd Hospital, Advocate Lutheran General Hospital