Effectiveness of intravenous dexamethasone, metoclopramide, ketorolac, and chlorpromazine for pain relief and prevention of recurrence in the migraine headache: a prospective double-blind randomized clinical trial

Khazaei, Mojtaba; Mir, Nahid Hosseini Nejad; Aghdam, Fateme Yadranji; Taheri, Mohammad; Ghafouri‐Fard, Soudeh

doi:10.1007/s10072-019-03766-x

Cited by 15 publications

(59 citation statements)

References 10 publications

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“…We identified two additional studies of ketorolac. One four-arm study randomized 128 patients to dexamethasone 8 mg, ketorolac 30 mg, metoclopramide 10 mg, or chlorpromazine 25 mg. 19 There were no substantial differences between the groups. A small study randomized 23 patients to intramuscular ketorolac or oral diclofenac and found no differences between the groups.…”

Section: Ketorolacmentioning

confidence: 83%

“…We identified three additional studies published in the interim. One four-arm study randomized 128 patients to dexamethasone 8 mg, ketorolac 30 mg, metoclopramide 10 mg, or chlorpromazine 25 mg. 19 There were no substantial differences between the groups. A second study randomized 90 patients to dexamethasone 8 mg or valproate 400 mg. 23 Both medications were highly effective, with dexamethasone outperforming valproate on some outcomes.…”

Section: Dexamethasonementioning

confidence: 83%

“…Based on four randomized studies, the AHS guideline endorsed the use of parenteral ketorolac with a rating of “may offer.” We identified two additional studies of ketorolac. One four‐arm study randomized 128 patients to dexamethasone 8 mg, ketorolac 30 mg, metoclopramide 10 mg, or chlorpromazine 25 mg 19 …”

Section: Other Medication Strategiesmentioning

confidence: 99%

“…We identified three additional studies published in the interim. One four‐arm study randomized 128 patients to dexamethasone 8 mg, ketorolac 30 mg, metoclopramide 10 mg, or chlorpromazine 25 mg 19 …”

Section: Other Medication Strategiesmentioning

confidence: 99%

“…We identified one new double-blind RCT trial published after the guideline. 19 The study randomized 128 patients to one of four groups; each participant received one of the following drugs intravenously: dexamethasone 8 mg, ketorolac 30 mg, metoclopramide 10 mg, or chlorpromazine 25 mg. The severity of headache was assessed at the starting point, 1 h after treatment, and 24 h after treatment.…”

Section: Chlorpromazinementioning

confidence: 99%

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Second‐line interventions for migraine in the emergency department: A narrative review

et al. 2021

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Objective Millions of patients present to US emergency departments (ED) annually for the treatment of migraine. First‐line treatments, including metoclopramide, prochlorperazine, and sumatriptan, fail to provide sufficient relief in up to one‐third of treated patients. In this narrative review, we discuss the evidence supporting the use of injectable (intravenous, intramuscular, or subcutaneous) medications for patients in the ED who fail to improve sufficiently after treatment with first‐line medication. Methods We used the American Headache Society's guideline, “Management of Adults with Acute Migraine in the Emergency Department: The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies,” published in 2016, to identify first‐line medications for migraine. We then conducted a PubMed search to determine whether any evidence supported the use of these medications as second‐line therapy and whether any evidence existed to support the use of injectable therapies not discussed in the guideline as second‐line therapy. Results We identified only scant high‐quality randomized data of second‐line therapy. Therefore, we based our recommendations on medications that have reliably demonstrated efficacy as first‐line treatment of migraine. These medications include injectable non‐steroidal anti‐inflammatory drugs (NSAIDs) and acetaminophen. Dihydroergotamine and valproic acid have some data supporting efficacy. More recently, greater occipital nerve blocks (GONBs) have been shown to be efficacious. With the exception of meperidine, opioids have been shown to be not efficacious. Most data published to date demonstrate no role for propofol and ketamine. Conclusions There are no evidence‐based second‐line treatments of migraine in the ED setting. For patients with migraine, who fail to improve after treatment with a first‐line medication, it is reasonable to use an intravenous NSAID or intravenous acetaminophen. Alternatively, clinicians adept at performing a GONB may offer this treatment.

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Section: Ketorolacmentioning

confidence: 83%

Section: Dexamethasonementioning

confidence: 83%

Section: Other Medication Strategiesmentioning

confidence: 99%

Section: Other Medication Strategiesmentioning

confidence: 99%

Section: Chlorpromazinementioning

confidence: 99%

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