Pain reduction and adverse effects of intravenous metoclopramide for acute migraine attack: A systematic review and meta-analysis of randomized-controlled trials

Abstract

BACKGROUND Metoclopramide may be used to treat people suffering from acute migraine. However, no comprehensive investigation on this issue has been recorded. This review will provide more solid evidence for the use of metoclopramide in treating acute migraine. AIM To compare the efficacy of intravenous metoclopramide with other therapies in migraine attack treatment in an emergency department (ED). METHODS We included randomized controlled trials of participants older than 18 years with acute migraine headaches, which included at least one arm that received intravenous (IV) metoclopramide at the ED. A literature search of PubMed, Web of Science, Cochrane Collaboration, and Reference Citation Analysis on December 31, 2021 retrieved other drugs or placebo-controlled studies without language limitation. The risk of bias was assessed using the Cochrane risk of bias tool. The primary endpoint was pain reduction at 60 min or closest to 1 h after treatment, as measured by the pain scale. Secondary endpoints included adverse effects or reactions resulting from metoclopramide or comparisons. RESULTS Fourteen trials with a total of 1661 individuals were eligible for review. The risk of bias ranged from low to intermediate. IV metoclopramide administration was not associated with higher pain reduction at 1 h (Standard mean difference [SMD] = -0.03, 95% confidence interval [CI]: -0.33-0.28, P = 0.87). However, metoclopramide was associated with better pain reduction than placebo (SMD = 1.04, 95%CI: 0.50-1.58, P = 0.0002). In addition, side effects were not significantly different between IV metoclopramide and other drugs or placebo (odds ratio [OR] = 0.76, 95%CI: 0.48-1.19, P = 0.09 and OR = 0.92, 95%CI: 0.31-2.74, P = 0.54, respectively). CONCLUSION Metoclopramide is more effective than placebo in treating migraine in the ED. Despite the observed tendency of decreased side effects, its effectiveness compared to other regimens is poorly understood. More research on this area is needed to treat migraine in acute care settings effectively.

The efficacy and safety of metoclopramide in relieving acute migraine attacks compared with other anti-migraine drugs: a systematic review and network meta-analysis of randomized controlled trials

“…These findings could make us conclude that it had nearly the same rate of complications compared with other drugs. Also, other studies supported what we found [ 39 , 42 ].…”

“…Regarding headache outcomes, many systematic reviews and meta-analyses proved its ability in decreasing headache scores [ 7 , 39 , 40 ]. This was in line with our results; however, our review included only the randomized controlled trials that investigated the metoclopramide alone without any combinations, besides we investigated different doses of metoclopramide at different times of follow-up.…”

Comparative Efficacy of Magnesium Sulphate and Dexamethasone/Metoclopramide in the Treatment of Acute Migraine Headaches

“…One possible explanation for the variability in outcomes is the interaction between dexamethasone and metoclopramide. A study by Corbo et al showed lower efficacy of metoclopramide when combined with magnesium sulfate compared to its use alone (14). Although our study did not combine metoclopramide with magnesium sulfate, the observed dampening effect when metoclopramide was combined with dexamethasone suggests a potential interaction that may reduce overall effectiveness.…”

Intravenous ketorolac versus metoclopramide in adult patients with migraine headaches: An updated systematic review and meta-analysis

“…on metoclopramide treatment for acute migraines, which suggests that metoclopramide is not associated with more significant adverse events than other kinds of medications. 22 There is a lack of experimental evidence regarding the possible mechanism of the anti-migraine effects of metoclopramide, but underlying dopamine D2 antagonism and the related decrease in trigeminovascular activation might explain the treatment efficacy of metoclopramide for acute migraines. 23 Dopamine D2 antagonism may be related to extrapyramidal side effects, such as Parkinsonism and acute dystonia.…”