Comparison of Intravenous Metoclopramide and Acetaminophen in Primary Headaches: a Randomized Controlled Trial
Archives of Academic Emergency Medicine,
Vol. 3 No. 2 (2015),
1 May 2015
,
Page 70-74
https://doi.org/10.22037/aaem.v3i2.269
Abstract
Introduction: Headache is the most common neurologic symptom among referees to the emergency department (ED), while the best treatment has not yet been found. Therefore, in the present study pain relief effects of metoclopramide and acetaminophen were compared in patients suffered acute primary headache. Methods: This study was a double-blind randomized clinical trial performed in Imam Khomeini Hospital, Urmia, Iran, through July to October 2014. All adult patients, with acute primary (migraine, tension type and cluster) headache referred to the ED were included in this study. Pain Severity was measured with 10 centimeters numeric rating scales. The patients were randomized in to two groups of intravenous (IV) metoclopramide (10 milligrams) and acetaminophen (1 gram). Pain score, success rate, and complication of drugs were compared within administration time and 15, 30, 60, as well as 120 minutes after medication. Results: 100 patients were equally categorized in to two groups (mean age of 32 ± 13.2 years; 51.2% male). Initial pain score in metoclopramide and acetaminophen groups were 9.1 and 9.4, respectively (p=0.46). IV metoclopramide did not have any analgesic effect at 15 minutes, but had good effect at 30 minutes. While, the analgesic effect of acetaminophen initiated after 15 minutes. After 2 hours, both drugs had good treatment effect on primary headaches (p<0.001). Conclusion: The present study demonstrated that efficacy of metoclopramide for pain relief in primary headaches is lower than acetaminophen. In this regard, success rate of acetaminophen was 42.0% versus 0% for metoclopramide within 15 minutes. The efficacy of acetaminophen continued until 60 minutes.- Metoclopramide
- Acetaminophen
- Headache
- Migraine
- Acute Pain
How to Cite
References
Taylor FR. Diagnosis and classification of headache. Prim Care. 2004;31(2):243-59.
McCaig LF, Nawar EW. National hospital ambulatory medical care survey: 2004 emergency department summary: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2006. p. 372.
Friedman BW, Hochberg ML, Esses D, et al. Applying the International Classification of Headache Disorders to the emergency department: an assessment of reproducibility and the frequency with which a unique diagnosis can be assigned to every acute headache presentation. Ann Emerg Med. 2007;49(4):409-19.
Tek DS, McClellan DS, Olshaker JS, Allen CL, Arthur DC. A prospective, double-blind study of metoclopramide hydrochloride for the control of migraine in the emergency department. Ann Emerg Med. 1990;19(10):1083-7.
Diamond S, Bigal ME, Silberstein S, Loder E, Reed M, Lipton RB. Patterns of diagnosis and acute and preventive treatment for migraine in the United States: results from the American Migraine Prevalence and Prevention study. Headache. 2007;47(3):355-63.
Goadsby PJ, Lipton RB, Ferrari MD. Migraine—current understanding and treatment. N Engl J Med. 2002;346(4):257-70.
Wood AJ, Goadsby PJ, Lipton RB, Ferrari MD. Migraine—Current Understanding and Treatment. N Engl J Med. 2002;346(4):257-70.
Vinson DR. Treatment patterns of isolated benign headache in US emergency departments. Ann Emerg Med. 2002;39(3):215-22.
Coppola M, Yealy DM, Leibold RA. Randomized, placebo-controlled evaluation of prochlorperazine versus metoclopramide for emergency department treatment of migraine headache. Ann Emerg Med. 1995;26(5):541-6.
Talabi S, Masoumi B, Azizkhani R, Esmailian M. Metoclopramide versus sumatriptan for treatment of migraine headache: A randomized clinical trial. J Res Med Sci. 2013;18(8):695.
Ashina S, Portenoy RK. Intravenous treatment of migraine. Tech Reg Anesth Pain Manag. 2012;16(1):25-9.
Coppola M, Yealy DM, Leibold RA. Randomized, placebo-controlled evaluation of prochlorperazine versus metoclopramide for emergency department treatment of migraine headache. Annals of emergency medicine. 1995;26(5):541-6.
Olesen J, Steiner T. The International classification of headache disorders, 2nd edn (ICDH-II). J Neurol Neurosurg Psychiatry. 2004;75(6):808-11.
Todd KH, Funk KG, Funk JP, Bonacci R. Clinical significance of reported changes in pain severity. Ann Emerg Med. 1996;27(4):485-9.
Tfeltâ€Hansen P, Block G, Dahlöf C, et al. Guidelines for controlled trials of drugs in migraine. Cephalalgia. 2000;20(9):765-86.
Turkcuer I, Serinken M, Eken C, et al. Intravenous paracetamol versus dexketoprofen in acute migraine attack in the emergency department: a randomised clinical trial. Emerg Med J. 2014:182-5.
Colman I, Friedman BW, Brown MD, et al. Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ. 2008;336(7657):1359-61.
Salazar-Zúñig A, Garfias-Arvizu A. Management of the acute migraine episode with sumatriptan vs. metoclopramide. Rev Biomed. 2006;17:175-82.
Cameron JD, Lane PL, Speechley M. Intravenous chlorpromazine vs intravenous metoclopramide in acute migraine headache. Acad Emerg Med. 1995;2(7):597-602.
Colman I, Brown MD, Innes GD, Grafstein E, Roberts TE, Rowe BH. Parenteral metoclopramide for acute migraine: meta-analysis of randomised controlled trials. BMJ. 2004;329(7479):1369-73.
Friedman BW, Adewunmi V, Campbell C, et al. A randomized trial of intravenous ketorolac versus intravenous metoclopramide plus diphenhydramine for tension-type and all nonmigraine, noncluster recurrent headaches. Ann Emerg Med. 2013;62(4):311-8. e4.
Friedman BW, Esses D, Solorzano C, et al. A randomized controlled trial of prochlorperazine versus metoclopramide for treatment of acute migraine. Ann Emerg Med. 2008;52(4):399-406.
Friedman BW, Garber L, Yoon A, et al. Randomized trial of IV valproate vs metoclopramide vs ketorolac for acute migraine. Neurology. 2014;82(11):976-83.
Weinman D, Nicastro O, Akala O, Friedman BW. Parenteral treatment of episodic tension-type headache: a systematic review. Headache. 2014;54(2):260-8.
Friedman BW, Mulvey L, Esses D, et al. Metoclopramide for acute migraine: a dose-finding randomized clinical trial. Ann Emerg Med. 2011;57(5):475-82.e1.
- Abstract Viewed: 318 times
- PDF Downloaded: 2845 times
- HTML Downloaded: 63 times