Randomized trial of IV valproate vs metoclopramide vs ketorolac for acute migraine

Abstract

This study provides Class I evidence that in ED patients with acute migraine, IV valproate is inferior to metoclopramide or ketorolac in improving headache outcomes.

Intravenous caffeine versus intravenous ketorolac for the management of moderate to severe migraine headache

“…Therefore, these authors recommended ketorolac as a second line therapy in these cases (Taggart et al, 2013). In a randomized study not included in the meta-analysis, Friedman et al, reported similar findings in regards to the effectiveness of ketorolac in managing migraine headaches-a decrease in pain scale scores of 3.9 units (Friedman et al, 2014). Meredith et al, compared the effectiveness of sumatriptan and ketorolac on emergency department migraine management, finding the latter to be more effective (Meredith et al, 2003).…”

Efficacy measurement of ketorolac in reducing the severity of headache

“…In another study which performed on patients presenting with migraine headache, it was shown that one dose injection of ketorolac can lead to significant decrease in headache symptoms after 1 hour in most participants (25). In a randomized trial for comparing the effectiveness of intravenous ketorolac, metoclopramide, and valproate sodium for management of acute migraine headache, it was concluded that ketorolac was superior to valproate sodium but less efficacious than metoclopramide (26). Intravenous ketorolac was also compared with intravenous diphenhydramine plus metoclopramide for treatment of some primary headaches.…”

Critical reappraisal of intravenous metoclopramide in migraine attack: a systematic review and meta-analysis

“…This was a randomized, double-blind study with a well-defined study protocol, allocation concealment, and intention-to-treat analysis [10]. There were 3 intervention arms that were 1 g IV valproate, 10 mg metoclopramide, and 30 mg ketorolac.…”

“…There is no lost to follow-up at 1 h. However, 3 patients in prochlorperazine group and 1 patient in metoclopramide group were lost to follow-up at 24 h. Friedman et al [10] Single-center randomized trial with online randomnumber generator…”

“…The pain change at the first hour was comparable between 2 arms (5.2 vs 5.5 cm, respectively), and this is also true for rescue drug need (17% vs 9%, respectively; difference, 8% [− 8 to 24]). The third study by Friedman et al [10] compared 3 study arms, 1 g IV valproate, 10 mg metoclopramide, and 30 mg ketorolac. All study arms improve the pain effectively at the first hour; however, mean difference between groups for primary outcome was 1.9 (95% CI, 1.1-2.8) for valproate vs metoclopramide, 1.1 (95% CI, 0.2-2) for ketorolac and valproate, and 0.8 (95% CI, 0.1-1.7) for metoclopramide and ketorolac indicating the superiority of metoclopramide to valproate but not for ketorolac.…”