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Migraine is an extraordinarily common primary headache disorder, and the majority of sufferers rely solely on non-prescription analgesics such as paracetamol for relief. In a survey of 165 000 individuals in the USA, 68% of people with migraine reported using paracetamol for acute attacks at least monthly, and 35% of those with chronic migraine used paracetamol an average of 19 days monthly.1 Antiemetics like metoclopramide are often prescribed in combination therapy with analgesics like paracetamol.
Massey and colleagues systematically evaluated randomised, double-blind, placebo- or active comparator-controlled studies in which paracetamol with or without an antiemetic was used to treat acute migraine attacks. The authors identified studies by searching Cochrane CENTRAL, MEDLINE, EMBASE, the Oxford Pain Relief Database and online clinical trial registries. Other inclusion criteria were age ≥18 years, ≥10 participants per treatment arm and a migraine diagnosis by International Headache Society criteria or another closely resembling definition.
Patients were not excluded based on migraine frequency, aura status or the presence of concomitant prophylaxis. If adjunctive antiemetic therapy was a treatment arm, it had to be self-administered ≤30 min prior …
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