The efficacy of metoclopramide in the treatment of migraine headache

Ellis, George L.; Delaney, John; Dehart, David A.; Owens, Ada

doi:10.1016/s0196-0644(05)80201-x

Cited by 121 publications

(118 citation statements)

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“…Clinical studies indicate that metoclopramide is an effective agent against migraine-associated nausea, vomiting, photophobia, and phonophobia [26]. Recent reports also suggest a pain-relieving effect of metoclopramide in migraine, but the evidence is weak [27,28]. This concurs with recent reports of dopamine supersensitivity in migraineurs, particularly in provocation of nausea and vomiting [9].…”

Section: Ergot Derivativessupporting

confidence: 73%

Treatment of childhood headaches

Gupta

Rothner

2001

Curr Neurol Neurosci Rep

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Migraine and tension-type headaches are two of the most common types of primary headache disorders in children. Migraine is a primary central nervous system disorder characterized by triggered or spontaneous episodes of activation of trigemino-vascular complex, neurogenic inflammation around vessels and meninges, and stimulation of the peripheral and central pain pathways of the trigemino-cervical complex. The triptans, by their selective agonistic action on 5-HT1B/1D receptors, are very effective in the treatment of migraine pain and associated symptoms. Early studies on the safety and efficacy of triptans in the management of childhood migraine show encouraging results. We propose a stratified-care model for the management of migraine in children, and discuss pharmacotherapy based on the pathophysiologic mechanisms of migraine pain. Management of tension-type headaches requires comprehensive medical and psychologic evaluation and an individualized approach for a successful outcome.

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Section: Ergot Derivativessupporting

confidence: 73%

Treatment of childhood headaches

Gupta

Rothner

2001

Curr Neurol Neurosci Rep

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“…Numerous agents, including nonsteroidal anti-inflammatory drugs (NSAIDs), 1,2 antiemetics, [3][4][5][6] phenothiazines 3,7-13 and serotonin agonists 1,3,8,9,[14][15][16][17][18][19][20] alleviate acute migraines. Valid comparative trials are scarce, but available data suggest that in the absence of drugdependence the likelihood of success with any of these agents is 60% to 70%.…”

Section: Introductionmentioning

confidence: 99%

Dexamethasone prevents relapse after emergency department treatment of acute migraine: a randomized clinical trial

Innes

MacPhail

Dillon

et al. 1999

CJEM

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ABSTRACT:Objective: To determine whether the addition of intravenous dexamethasone to standard emergency department (ED) migraine therapy would decrease the incidence of severe recurrent headache 24 to 48 hours after initial treatment. Methods: Patients aged 19 to 65 years whose headache was severe enough to require parenteral therapy and who met International Headache Society migraine criteria were eligible for this randomized, double-blind trial. The study was conducted in the ED of 2 community hospitals, 1 of which was a tertiary referral centre. Exclusion criteria included pregnancy, focal findings, fever, meningismus, allergy to the study drug, active peptic ulcer disease and diabetes mellitus. Demographic and clinical data, including headache severity, were recorded. After abortive therapy (antiemetics, intravenous nonsteroidal agents, dihydroergotamine or opioids), blinded nurses administered dexamethasone (24 mg intravenously) or placebo. Patients recorded headache severity on a Visual Analogue Scale (VAS) at time T = 0, T = 30 minutes and T = 60 minutes and at discharge. They were contacted 48 to 72 hours later and asked whether they had suffered a recurrence of their headache, categorized as class A (severe, provoking another physician visit), class B (severe, interfering with daily activity but not provoking a physician visit), class C (mild, requiring self-medication but not limiting activity) or class D (mild, requiring no treatment). Results: Two of 100 patients were lost to follow-up, leaving 98 in the study sample. Placebo recipients were more likely to be female; other baseline characteristics were similar between groups. Median VAS pain score was 83 mm on ED arrival, 35 mm after initial treatment and 12 mm on discharge. At followup, 65 of 98 patients had suffered headache recurrence. In the placebo versus dexamethasone groups, respectively, the results were 11 versus 0 in class A, 11 versus 9 in class B, 7 versus 11 in class C and 4 versus 12 in class D. Regarding the primary outcome, 9 of 49 dexamethasone patients (18%) and 22 of 49 placebo patients (45%) had severe (classes A and B) recurrent headache (odds ratio 0.28; 95% CI, 0.11 to 0.69; p = 0 .005). Conclusions: Migraine recurrence is common after "successful" ED treatment. Inflammation may be a critical factor in migraine genesis. Intravenous dexamethasone decreases the incidence of severe recurrent headache after ED treatment and should be offered to patients thought to be at risk of recurrent headache.

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“…The study by Ellis et al [6] was excluded from the meta-analysis because of the low study quality, which was a proper decision.…”

Section: Interpreting the Resultsmentioning

confidence: 99%

“…The study by Ellis et al [6] compared 4 arms including IV metoclopramide vs IV placebo vs oral ibuprofen and oral placebo, which has a small sample size with 10 patients in each group. The study was stated as randomized, but the randomization procedure was unspecified, and the authors did not define how the patients were enrolled to the study.…”

Section: Ellis Et Almentioning

confidence: 99%