100 Migraine Drugs, A to Z: droperidol

Droperidol (Inapsine) is not a phenothiazine, but is structurally very similar to this class of anti-nausea and anti-psychotic drugs. It also has similar properties of relieving nausea and being a major tranquilizer. And just like phenothiazines (prochlorperazine or Compazine, chlorpromazine or Thorazine, and other) it helps relieve migraines.

An intravenous infusion of droperidol stopped a very severe and prolonged migraine that failed to respond to other treatments in 30 out of 35 patients. Most of them became drowsy from the drug and 5 developed severe restlessness and involuntary movements (akathisia).

Intravenous and intramuscular droperidol has been shown to be more effective than prochlorperazine in an emergency room setting, but it had more side effects. Akathisia and sedation were present in 15% of patients.

A randomized, double-blind, placebo-controlled trial of droperidol injected intramuscularly involving over 300 patients showed its efficacy in treating migraines. However, droperidol produced the same problematic side effects as all phenothiazines can. In this trial 30% of patients had anxiety, akathisia (restlessness and inability to stay still), and somnolence that was rated as severe. Intravenous diphenhydramine (Benadryl) can help reduce these side effects. Another potentially serious side effect is irregular heart beat, or cardiac arrhythmia, which can be life-threatening.

Over the years I’ve given droperidol on a rare occasion in the office without few side effects and with good relief. However, because of the potential for serious side effects I no longer administer it. Fortunately, we have many other intravenous drugs to stop a severe persistent migraine – magnesium, ketorolac (Toradol), dihydroergotamine (DHE-45), ondansetron (Zofran), metoclopramide (Reglan), dexamethasone (Decadron), valproic acid (Depakene), and other.