This is a fun study because it’s always nice to have new things to try for common problems. Keeps life interesting.
I started out residency taught to use metoclopromide+diphenhydramine for treatment of refractory headache in the Emergency Department. And then I discovered droperidol. Yes, there are studies out there that say prochlorperazine is equivalent to droperidol in efficacy, but prochlorperazine gives people the same akathisia that metoclopromide does. Droperidol kills people dead, if you believe the black box – though I don’t. The QT-prolongation is essentially no different than ondansetron, the supposedly-safe alternative we now use for nausea.
In any event, now you can add olanzapine to your mix. You can legitimately critique the study because the p-value for pain improvement between olanzapine and droperidol was actually 0.30 in favor of droperidol – so without more power and/or a second confirmatory study, you can say it really might not be as effective. But, the good thing is, nearly everything has some legitimate effectiveness – and the more different classes of medication you have available to knock down that headache, the better.