Paracetamol (acetaminophen) with or without an antiemetic for acute migraine headaches in adults

Derry, Sheena; Moore, R Andrew

doi:10.1002/14651858.cd008040.pub3

Cited by 93 publications

(72 citation statements)

References 72 publications

(17 reference statements)

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“…A recent systematic review con-cluded that acetaminophen 1000 mg plus metoclopramide 10 mg had 2-hour headache relief rates similar to those of sumatriptan 100 mg (39% vs 42%, respectively). 9 NSAIDs.-The NSAIDs are generally a good starting point for acute migraine treatment, although acetaminophen can be tried if there are contraindications to NSAID use, and triptans are another option. Ibuprofen, 10 naproxen sodium, 11 acetylsalicylic acid (ASA), 12 and diclofenac potassium 13 all have double-blind randomized controlled trial evidence for efficacy that has been analyzed in systematic reviews.…”

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confidence: 99%

“…11,19 Pharmacokinetics, dosages, and headache response rates (given as NNTs [number needed to treat]) for acetaminophen and the NSAIDs are shown in Table 1. 5,9,12,13,18,19 Combination analgesics with both acetaminophen and ASA have also been investigated for efficacy in acute migraine treatment. A combination of acetaminophen, ASA, and caffeine has been shown to have greater efficacy than any one of its components in comparable doses alone.…”

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Acute Migraine Treatment in Adults

Becker

2015

Headache

148

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There are many options for acute migraine attack treatment, but none is ideal for all patients. This study aims to review current medical office-based acute migraine therapy in adults and provides readers with an organized approach to this important facet of migraine treatment. A general literature review includes a review of several recent published guidelines. Acetaminophen, 4 nonsteroidal anti-inflammatory drugs (NSAIDs) (ibuprofen, acetylsalicylic acid [ASA], naproxen sodium, and diclofenac potassium), and 7 triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan) have good evidence for efficacy and form the core of acute migraine treatment. NSAID-triptan combinations, dihydroergotamine, non-opioid combination analgesics (acetaminophen, ASA, and caffeine), and several anti-emetics (metoclopramide, domperidone, and prochlorperazine) are additional evidence-based options. Opioid containing combination analgesics may be helpful in specific patients, but should not be used routinely. Clinical features to be considered when choosing an acute migraine medication include usual headache intensity, usual rapidity of pain intensity increase, nausea, vomiting, degree of disability, patient response to previously used medications, history of headache recurrence with previous attacks, and the presence of contraindications to specific acute medications. Available acute medications can be organized into 4 treatment strategies, including a strategy for attacks of mild to moderate severity (strategy one: acetaminophen and/or NSAIDs), a triptan strategy for patients with severe attacks and for attacks not responding to strategy one, a refractory attack strategy, and a strategy for patients with contraindications to vasoconstricting drugs. Acute treatment of migraine attacks during pregnancy, lactation, and for patients with chronic migraine is also discussed. In chronic migraine, it is particularly important that medication overuse is eliminated or avoided. Migraine treatment is complex, and treatment must be individualized and tailored to the patient's clinical features. Clinicians should make full use of available medications and formulations in an organized approach.

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Acute Migraine Treatment in Adults

Becker

2015

Headache

148

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“…15 In studies comparing the effects of paracetamol and placebo, the effect ranges between 52 to 70% and 32 to 46%, respectively. 16 Paracetamol 1,000 mg can therefore also be considered a suitable treatment alternative with comparable efficacy for pain relief within 2 hours.…”

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confidence: 99%

Efficacy and Safety of 400 and 800 mg Etodolac vs. 1,000 mg Paracetamol in Acute Treatment of Migraine: A Randomized, Double‐blind, Crossover, Multicenter, Phase III Clinical Trial

et al. 2012

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“…In addition, many patients choose not to seek professional help and rely on over-the-counter analgesics. 3…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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.

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Paracetamol (acetaminophen) with or without an antiemetic for acute migraine headaches in adults

Cited by 93 publications

References 72 publications

Acute Migraine Treatment in Adults

Acute Migraine Treatment in Adults

Efficacy and Safety of 400 and 800 mg Etodolac vs. 1,000 mg Paracetamol in Acute Treatment of Migraine: A Randomized, Double‐blind, Crossover, Multicenter, Phase III Clinical Trial

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

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