Parenteral metoclopramide for acute migraine: meta-analysis of randomised controlled trials

Colman, Ian; Brown, Michael D.; Innes, Grant; Grafstein, Eric; Roberts, Theodore S.; Rowe, Brian H.

doi:10.1136/bmj.38281.595718.7c

Cited by 157 publications

(114 citation statements)

References 22 publications

(58 reference statements)

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“…Chlorpromazine, [21] droperidol, [22] prochlorperazine, [23] and metoclopramide [24] have shown anti-migraine effi cacy and are relatively inexpensive. Prochlorperazine intravenously is just as or more effective than intravenous metoclopramide.…”

Section: Antiemetic Dopamine Antagonistsmentioning

confidence: 99%

The presenting and prescribing patterns of migraine in an Australian emergency department: A descriptive exploratory study

Shao

Hughes

Eley

2017

World Journal of Emergency Medicine

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BACKGROUND:Migraine is a common neurological condition that frequently presents to the emergency department (ED). Many medications are available to treat migraine. This study aims to characterize the demographics of patients who present to a large metropolitan ED with migraine, and to identify the medications used in treating this condition. METHODS:This study is a retrospective database interrogation of clinical records, used to collect quantitative data on patient demographics and medication prescriptions in the ED.RESULTS: A total of 2 228 patients were identified as being treated for migraine over a 10-year period. The proportion of the ED population presenting with migraine steadily increased in this time. Females (71%) more commonly presented to the ED with migraine than males. The migraine population was signifi cantly younger (M=37.05, SD=13.23) than the whole ED population (M=46.17 SD=20.50) (P<0.001). A variety of medications were used in the treatment of migraine in the ED. Simple analgesics such as paracetamol and ibuprofen, anti-emetics and intravenous (IV) fluids with phenothiazine additives were commonly used. Over 20% of patients were prescribed oral or parenteral opiates (42 of 194 initial medication prescriptions, and 64 of 292 as required medication prescriptions). Triptans were very rarely used. CONCLUSION:Migraine is an increasingly common presentation to the ED. People presenting to the ED with migraine are more likely to be younger and female than the general ED population. Peak presentations for migraines occurred in January and February. The medications that are prescribed in the ED for migraine is varied and are not always in line with current evidence for the treatment of migraine. The excessive reliance on opiates and lack of the use of triptans denotes a signifi cant variation from published guidelines.

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Section: Antiemetic Dopamine Antagonistsmentioning

confidence: 99%

The presenting and prescribing patterns of migraine in an Australian emergency department: A descriptive exploratory study

Shao

Hughes

Eley

2017

World Journal of Emergency Medicine

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“…Most compelling is the fact that D 2 -like receptor antagonists, such as prochlorperazine (Jones et al, 1996), metoclopramide (Colman et al, 2004), droperidol (Silberstein et al, 2003), and domperidone [5-chloro-1-[1-[3-(2,3-dihydro-2-oxo-1H-benzimidazol-1-yl)propyl]-4-piperidinyl]-1,3-dihydro-2H-benzimidazol-2-one] (Waelkens, 1984), have been used to treat migraine, although none has an exclusively dopaminergic pharmacology. It has been shown that stimulation of dural (Akerman and Goadsby, 2005), coronary, renal, and mesenteric vascular D 2 -like receptors causes indirect vasodilatation by inhibition of sympathetic vasoconstrictor tone (Lahlou, 1998;Amenta et al, 2002).…”

mentioning

confidence: 99%

Comparison of the Effects of Central and Peripheral Dopamine Receptor Activation on Evoked Firing in the Trigeminocervical Complex

Charbit

Akerman²,

Goadsby³

2009

J Pharmacol Exp Ther

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Dopaminergic mechanisms have been suggested to play a role in migraine. Here, electrophysiological techniques were used to study the effects of intravenously administered centrally or peripherally active dopamine receptor agonists and antagonists on evoked firing in the trigeminocervical complex (TCC). After establishing baseline firing evoked by electrical stimulation of the dural middle meningeal artery (MMA) and mechanical noxious and innocuous stimulation of the ophthalmic dermatome, D 1 -or D 2 -like receptor agonists or antagonists were administered intravenously and the effect on firing was determined. In addition, with use of intravital microscopy, we monitored changes in dural vessel diameter in response to varying doses of D 1 -or D 2 -like receptor agonists to determine whether their effects were related to blood vessel caliber. The central -like receptor agonists cis-(Ϯ)-1-(aminomethyl)-3,4-dihydro-3-phenyl-1H-2-ben-zopyran-5,6-diol hydrochloride (A68930 hydrochloride) and dihydrexidine facilitated innocuous brush-evoked firing, with A68930 hydrochloride having the greatest effect. The data suggest that dopamine binding to peripheral D 1 -like receptors may play a role in peripheral sensitization, and that the inhibitory or excitatory effects seen with administration of dopamine receptor agonists are independent of blood vessel changes. In addition, these studies maintain that central D 2 -like receptors inhibit trigeminocervical neurons, and may provide insight into the conflicting literature on the role of dopamine and its receptors in migraine.

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“…La metoclopramida presentó en nuestro estudio una alta eficacia en el control del dolor agudo de las crisis de migraña llegando al 80,2% de los pacientes que mostraron una reducción ≥ 50% de la EVA del ingreso, ésta eficacia fue mayor a la reportada en una revisión que encontró 53,4% de eficacia del fármaco en el control del dolor (7). Resultados que confirman la elevada eficacia del medicamento en los pacientes con migraña.…”

Section: Discussionunclassified

“…La metoclopramida, un procinético antagonista de los receptores D2 de dopamina, ha demostrado ser efectiva en el tratamiento del dolor de las crisis de migraña en diversos estudios (7,8) y se ha considerado eficaz en el control de los síntomas digestivos como las náuseas y los vómitos, ya sea sola o administrada junto a un analgésico (9,10).…”

Section: Introductionunclassified

Eficacia y efectos adversos de la metoclopramida endovenosa en el tratamiento de las crisis de migraña.

Lira¹,

Custodio²,

Herrera-Pérez³

et al. 2014

Rev Neuropsiquiatr

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RESUMENObjetivos: Determinar los efectos adversos de la metoclopramida endovenosa en el tratamiento agudo de las crisis de migraña. Pacientes y métodos: Se evaluaron pacientes con diagnóstico confirmado de migraña según los criterios de la International Headache Society, que acudieron refiriendo crisis de migraña por emergencia o consultorio externo de neurología. Se recogieron los datos demográficos y se determinó la intensidad del dolor mediante la escala visual análoga (EVA) de 0 a 10. A cada paciente se le administró metoclopramida diluida vía endovenosa. Se determinaron la eficacia en la disminución de la intensidad del dolor y los efectos adversos. Resultados: Se evaluaron 76 pacientes de 18 a 56 años de edad, 77,6% fueron mujeres. La EVA basal promedio de ingreso fue de 8,6, después de recibir metoclopramida EV 80,2% presentaron reducción en la EVA ≥ 50%. 92,1% de los pacientes mostraron algún efecto adverso siendo los más frecuentes inquietud psicomotora, somnolencia, insomnio y mareos. Conclusiones: La metoclopramida endovenosa es un tratamiento efectivo en el control de las crisis de migraña y produce muy frecuentes efectos adversos como inquietud psicomotora, somnolencia, insomnio y mareos; lo que debe advertirse antes de su administración.PALABRAS CLAVE: Cefalea, eficacia, efectos adversos, metoclopramida, migraña. SUMMARY Objectives:Determine the adverse effects of intravenous metoclopramide in the acute treatment of migraine attacks. Patients and methods:Were evaluated patients with a confirmed diagnosis of migraine according to the criteria of the International Headache Society, they attended with migraine crisis to emergency or outpatient neurology. Demographic data were collected and pain intensity was determined by visual analog scale (VAS ) from 0 to 10. Each patient was given intravenous metoclopramide diluted. We determined the efficacy in reducing pain intensity and the side effects. Results: 76 patients were evaluated, of 18 to 56 years old, 77,6 % were women. The average baseline VAS was 8,6 , after receiving metoclopramide EV 80,2 % had a reduction in VAS ≥ 50 %. The 92,1 % of patients had any adverse effects, were the most frequent psychomotor restlessness, drowsiness, insomnia and

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Parenteral metoclopramide for acute migraine: meta-analysis of randomised controlled trials

Cited by 157 publications

References 22 publications

The presenting and prescribing patterns of migraine in an Australian emergency department: A descriptive exploratory study

The presenting and prescribing patterns of migraine in an Australian emergency department: A descriptive exploratory study

Comparison of the Effects of Central and Peripheral Dopamine Receptor Activation on Evoked Firing in the Trigeminocervical Complex

Eficacia y efectos adversos de la metoclopramida endovenosa en el tratamiento de las crisis de migraña.

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