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Review: intravenous metoclopramide is better than placebo for reducing pain in acute migraine in the emergency department

Clinical impact ratings GP/FP/Primary care Neurology Emergency medicine

Key Words: antiemetics • metoclopramide • migraine

The first 150 words of the full text of this article appear below.

METHODS
Data sources: Medline; EMBASE/Excerpta Medica; LILACS; CINAHL; Cochrane Central Register of Controlled Trials; neurology, headache, and emergency medicine conference proceedings (1998–2004); clinical practice guidelines; websites; theses or dissertations; reference lists; and experts in the field.

Study selection and assessment: randomised controlled trials (RCTs) that compared parenteral metoclopramide with placebo, other antiemetics [AEs], non-AEs, or other antimigraine [AM] regimens in adults with an acute migraine in an emergency department (ED) or headache clinic, and distinguished migraine from other types of headaches. Study quality was assessed.

Outcomes: complete relief of headache, significant reduction in headache pain (from moderate or severe to mild or none), and reduction in headache pain on the basis of a 10 cm visual analogue scale (VAS). Secondary outcomes included relapse of migraine within 48 hours of treatment, nausea, number of rescue drugs required, functional status, and adverse effects.

MAIN RESULTS
13 RCTs (n = 655) met the selection criteria. 7 . . . [Full text of this article]

Elizabeth W Loder, MD

Spaulding Hospital, Boston, Massachusetts, USA