Objective
To compare intramuscular ketorolac tromethamine with intravenous chlorpromazine hydrochloride in treating acute migraine.

Methods
We performed a prospective, randomized, double-blind trial comparing the clinical effectiveness of 60 mg of intramuscular ketorolac tromethamine with 25 mg of intravenous chlorpromazine hydrochloride in patients with acute migraine headache seen in the emergency department. Pain intensity, quantitated using the Wong-Baker Faces Rating Scale, was measured every 30 minutes for 2 hours in the emergency department. Patients returned pain scores at 6, 12, 24, and 48 hours by mail.

Results
Fifteen patients were entered into each treatment arm. No differences were seen between the mean pain scores or the mean change in pain scores. The ketorolac group mean (±SEM) pain score decreased from 4.07±0.18 to 0.73±0.3 in 2 hours. The chlorpromazine group pain score decreased from 4.47±0.17 to 0.87±0.4. Two of the 3 nonresponders responded to the alternate group's treatment. No side effects were seen.

Conclusion
Using 60 mg of intramuscular ketorolac tromethamine is as effective as 25 mg of intravenous chlorpromazine hydrochloride in the treatment of acute migraine headache. Patients who do not respond to one of these medications may respond to the other.

Arch Intern Med. 1996;156:1725-1728