As per the recent study, the antipsychotic drug, "Ziprasidone" could be helpful in treating migraines among patients who don't respond to other treatments. These new findings were published in The Neurohospitalist.

As a first-line treatment for migraine, patients are typically treated with acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and caffeine, while second-line treatments include triptans, ketorolac, prochlorperazine, or metoclopramide. Neuroleptics and dopaminergic antagonists are often prescribed when above-mentioned drugs fail to provide the optimum relief.

Ziprasidone modulates the dopaminergic system in the same way as droperidol and haloperidol and overuses shown to attenuate the chronic daily headache significantly. With this knowledge, neurologists at Barnes-Jewish Hospital began to treat status migrainosus patients with intramuscular ziprasidone in 2008. For the retrospective chart review, researchers analyzed the data of 43 patients with status migrainosus treated with ziprasidone between 2008 and 2015. Data on the severity of migraines was available for 35 patients on admission and 39 patients on discharge, with a mean score of 8.9±1.5 and 3.0±2.9 on 0-10 Likert scale, respectively. On an average, 4.7±2.5 different medications were administered before to ziprasidone [not earlier than third-line].

The data was available for 34 patients on admission and discharge severity scores, with an average decrease in pain of 5.7±3.0. In this study, ziprasidone was considered useful in reducing migraines severity in 81% of cases. Furthermore, the drug was linked to discharge in 65% of cases.

In an attempt to determine how exactly ziprasidone affected the length of stay, researchers compared the patients in the ziprasidone arm with 20 patients who received droperidol and other abortive treatments except for ziprasidone. The results showed that patients in the ziprasidone arm had a median length of stay of 3 days, with a range of 1 to 8 days. While in the droperidol arm, patients had a median length stay of 4 days, with a range of 2 to 17 days. Researchers also found that 12% of patients who received ziprasidone within 30 days of initial discharge experienced headache recurrence. Adverse events from ziprasidone included a period of consolidated sleep, which was found in nearly all of the patients, and single reports of rhinorrhea, upper back dystonia, and asymptomatic prolongation of QTc.

Although the present study had supplied much useful information, it has several limitations such as there was no control group and consistent, systematic documentation of migraine severity and treatment results. Therefore, prospective, placebo-controlled studies are needed to further confirm the safety and efficacy of ziprasidone for status migrainosus. 

To conclude, ziprasidone may be an effective and fast-acting treatment option for patients with status migrainosus.