Treatment of Headache in the Emergency Department: Haloperidol in the Acute Setting (THE-HA Study): A Randomized Clinical Trial

J Emerg Med. 2020 May 10;S0736-4679(20)30349-8. doi: 10.1016/j.jemermed.2020.04.018. Online ahead of print.

Abstract

Background: Headache is a common complaint of emergency department (ED) patients and current treatment varies with significant limitations.

Objective: Our aim was to evaluate the efficacy and safety of 2.5 mg i.v. haloperidol in the treatment of severe benign headache in the ED.

Methods: A randomized, double-blind, placebo-controlled trial was performed in the ED of a single high-volume teaching hospital. Convenience sampling identified 287 eligible patients 13 to 55 years old with benign headache. One hundred and eighteen patients were enrolled to receive either 2.5 mg of haloperidol i.v. or placebo. The primary outcome measure was pain reduction at 60 min. Patients were evaluated for adverse events and follow-up was conducted after discharge. QT measurement was performed at baseline and discharge.

Results: Fifty-eight patients received haloperidol and 60 patients received placebo. Patients in the haloperidol group reported an average 4.77-unit reduction in visual analogue scale score at 60 min compared to a 1.87-unit reduction in the control group. Thirty-four patients (58.6%) in the haloperidol group had complete resolution of their headache. Treatment with rescue ketorolac was required in 78.3% of the control group and 31% of the haloperidol group. Adverse events were uncommon, benign, and easily treated. No patients in the haloperidol group were found to have QT lengthening.

Conclusions: This study suggests that 2.5 mg i.v. haloperidol is a rapid and effective treatment for acute, severe, benign headache in ED patients aged 18 to 55 years. Further study is warranted to confirm these results in adolescents.

Trial registration: ClinicalTrials.gov Identifier NCT02747511.

Keywords: QT; emergency department; haldol; haloperidol; headache; ketorolac; management; migraine; pain; pediatric; placebo; treatment.

Associated data

  • ClinicalTrials.gov/NCT02747511