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To the Editor:
Friedman et al.1 compared metoclopramide vs sumatriptan for the emergency department (ED) treatment of migraine with interest. Utilizing diphenhydramine in combination with metoclopramide may have affected the results of the comparison since diphenhydramine has been used independently as a treatment for migraine. The suggested treatment is one to three doses daily (25 to 50 mg) either intramuscularly or intravenously and is used essentially as an abortive agent.2 Diphenhydramine has also been recommended for severe attacks of migraine during pregnancy, with metoclopramide being restricted to the third trimester.3
There has been a recent study comparing IV diphenhydramine vs IV dihydroergotamine (DHE)-45 in the treatment of severe migraine headache.4 Combination treatment may provide benefit for patients who don’t respond to individual agents, such as combining metoclopramide with a triptan in triptan-nonresponsive migraineurs.5
Used alone, diphenhydramine may have therapeutic effectiveness for headaches in addition to preventing akathisias and other dystonic reactions for which it was utilized in the present study. …
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