Intravenous metoclopramide in the treatment of acute migraines: A randomized, placebo-controlled trial

Abstract

Objectives:The present study aimed to evaluate the efficacy and safety of intravenous metoclopramide for acute migraine treatment. Materials and methods:A double-blind, randomized, parallel-group, placebo-controlled trial was carried out in an academic emergency department. After the patients were assessed for eligibility via the International Headache Society criteria for migraines, they were randomized into 10 mg intravenous metoclopramide and normal saline groups. The headache intensity was evaluated using an 11-point numeric rating scale (NRS) score. The primary outcome measure was determined as the median between-group change in the score at the 30th minute. The secondary outcome measures were rescue medication needs, adverse events, and emergency department (ED) revisits after discharge. Results: A total of 148 patients were randomized into two equal groups with similar baseline characteristics, including the baseline NRS scores (8 points). The median reduction in the NRS scores at the 30th minute was 4 [interquartile range (IQR): 2-6)] in the metoclopramide group and 3 (IQR: 1-4) in the normal saline group [median difference: −1.0, 95% confidence interval (CI): −2.1 to 0.1]. No serious adverse events were observed, and the rescue medication needs were similar in both groups. Conclusion: No difference was found between intravenous metoclopramide and placebo regarding efficacy and safety in patients with acute migraines. K E Y W O R D S emergency department (MeSH Database), headache, metoclopramide, migraine How to cite this article: Doğan NÖ, Pekdemir M, Yılmaz S, et al. Intravenous metoclopramide in the treatment of acute migraines: A randomized, placebo-controlled trial.

Acute Treatments for Episodic Migraine in Adults

“…Twenty-six RCTs with 2561 patients evaluated antiemetic medications. The overall risk of bias was moderate to high (4 RCTs with low risk; 8, moderate risk; and 14, high risk) (eTable 11 in the Supplement).…”

The effectiveness of parenteral agents for pain reduction in patients with migraine presenting to emergency settings: A systematic review and network analysis

“…The remaining studies most frequently utilized a 4-point verbal rating scale (i.e., 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain) [35][36][37][38][39]41,42,44,52,62,63,66,68,72,75,96,97,101,106,108,109,118,[120][121][122]124,[126][127][128][129] or a 10-or 11-point numeric rating scale. 10,11,40,45,[55][56][57][58]84,85,89,92,100,102,106,115,116,130 Six studies measured pain using other scales including the Borg scale, 50 an unspecified 1-5 point Likert scale, 69 a 0-4 poi...…”

“…reported their source of funding or declared potential conflicts of interest 11,40,42,44,46,47,50,54,[56][57][58]64,66,68,71,72,[75][76][77][78][79][80][81]83,84,86,[89][90][91]95,98,99,106,[108][109][110][111]115,118,125,130 while potential conflict of interest was identified in 16 studies 42,44,47,50,66,68,71,72,75,76,106,…”

Pathophysiology and Therapy of Associated Features of Migraine

“…Metoclopramide helps with the impairment of gastric motility during migraine attacks, improving the absorption rate of NSAIDs [ 87 ], and may also exert its effect as a pain relief agent [ 88 ], probably due to its action in the trigemino–cervical complex [ 89 ]. However, recent literature found conflicting results as a single therapeutic approach, with either an efficacy similar to that of NSAIDs [ 90 ], or no difference of intravenous metoclopramide compared to saline [ 91 ]. Prochlorperazine is a phenothiazine antipsychotic with antagonizing effect of dopamine D 2 receptors, similar to chlorpromazine [ 87 , 92 ] and might be the most effective intravenous antiemetic, which also has a higher risk of extrapyramidal adverse events [ 93 ].…”