A 35 year old female with a history of headaches presents with….a headache. After a thorough history and neuro exam, you deem this a benign headache. What do you reach for? Toradol and reglan. But what if there was something else you could add to your arsenal at the same time to really knock this thing out? There may be: benadryl. Few studies have been performed, but of these, some interesting results have been realized.
[spacer height=”20px”]Benjamin Friedman at Montefiore has been studying this for a bit and has a new study in the works. He performed a randomized trial on 120 participants comparing toradol to reglan/diphenhydramine, for the purpose of reducing the side effect of akathisia, and found that in fact, this combination may act to help with the headache as well. His results: “Patients who received the combination of metoclopramide and diphenhydramine achieved better pain improvement within 1 hour (pain score decrease of 5 versus 3 out of 10), were more likely to achieve “sustained headache freedom” during their ED course (45% vs 27%), less likely to need an extra rescue medication (13% vs 45%), and more likely to have “sustained headache freedom” 24 hours later (27% vs 8%).” Now is reglan just better than toradol? Some studies point to yes. As such, Friedman is now working on a project to compare reglan plus benadryl to reglan alone in headache management.
[spacer height=”20px”]While no true efficacy has been proven at this point, there is virtually no harm in adding benadryl, it will reduce the chances of dystonic reactions, and may potentially help with the headache itself, so why not give it a try?
Friedman BW, et al. A Randomized Trial of Intravenous Ketorolac Versus Intravenous Metoclopramide Plus Diphenhydramine for Tension-Type and All Nonmigraine, Noncluster Recurrent Headache. Annals of Emergency Medicine. October 2013;62(4):311-318
[spacer height=”20px”]Pearl inspired by Dr.’s Cruz, Heller and Andreae