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A trial of metoclopramide vs sumatriptan for the emergency department treatment of migraines.
Neurology. 2005 Feb 08; 64(3):463-8.Neur

Abstract

OBJECTIVE

To compare the efficacy of 20 mg of IV metoclopramide, given up to four times over 2 hours as needed for persistent headache, with 6 mg of subcutaneous sumatriptan for the emergency department treatment of migraine headaches.

METHODS

This was a randomized, double-blind, clinical trial with two intervention arms. The primary endpoint was change in pain intensity as measured by an 11-point pain scale at 2 hours. Secondary endpoints included change in pain intensity at 24 hours and rates of pain-free headache relief at 2 and 24 hours.

RESULTS

Two hundred two patients were screened, and 78 of 91 eligible patients were randomized. The two groups had comparable pain scores at baseline. By 2 hours, the change in pain intensity for the metoclopramide group was 7.2 compared with 6.3 for the sumatriptan group (95% CI for difference: -0.2 to 2.2). When compared at 24 hours, the metoclopramide group had improved by 6.1 compared with baseline and the sumatriptan group had improved by 5.0 (95% CI for difference: -0.6 to 2.8). At 2 hours, pain-free rates were 59% in the metoclopramide arm and 35% in the sumatriptan arm (95% CI for difference of 24%: 2 to 46%). The most common side effects at both time points were weakness, dizziness, and drowsiness, which were distributed evenly between the two groups. There were no reports of chest pain within the first 2 hours. The incidence of restlessness, stiffness, and abnormal movements was distributed equally between the two groups.

CONCLUSIONS

When compared at 2 and 24 hours, aggressive (20 mg dosed up to four times) IV metoclopramide and 6 mg of subcutaneous sumatriptan relieved migraine headache pain comparably. Some secondary endpoints suggest that metoclopramide may be the preferable therapy for migraines presenting to the emergency department.

Authors+Show Affiliations

Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E. 210 St., Bronx, NY 10467, USA. befriedm@montefiore.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

15699376

Citation

Friedman, B W., et al. "A Trial of Metoclopramide Vs Sumatriptan for the Emergency Department Treatment of Migraines." Neurology, vol. 64, no. 3, 2005, pp. 463-8.
Friedman BW, Corbo J, Lipton RB, et al. A trial of metoclopramide vs sumatriptan for the emergency department treatment of migraines. Neurology. 2005;64(3):463-8.
Friedman, B. W., Corbo, J., Lipton, R. B., Bijur, P. E., Esses, D., Solorzano, C., & Gallagher, E. J. (2005). A trial of metoclopramide vs sumatriptan for the emergency department treatment of migraines. Neurology, 64(3), 463-8.
Friedman BW, et al. A Trial of Metoclopramide Vs Sumatriptan for the Emergency Department Treatment of Migraines. Neurology. 2005 Feb 8;64(3):463-8. PubMed PMID: 15699376.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A trial of metoclopramide vs sumatriptan for the emergency department treatment of migraines. AU - Friedman,B W, AU - Corbo,J, AU - Lipton,R B, AU - Bijur,P E, AU - Esses,D, AU - Solorzano,C, AU - Gallagher,E J, PY - 2005/2/9/pubmed PY - 2005/9/20/medline PY - 2005/2/9/entrez SP - 463 EP - 8 JF - Neurology JO - Neurology VL - 64 IS - 3 N2 - OBJECTIVE: To compare the efficacy of 20 mg of IV metoclopramide, given up to four times over 2 hours as needed for persistent headache, with 6 mg of subcutaneous sumatriptan for the emergency department treatment of migraine headaches. METHODS: This was a randomized, double-blind, clinical trial with two intervention arms. The primary endpoint was change in pain intensity as measured by an 11-point pain scale at 2 hours. Secondary endpoints included change in pain intensity at 24 hours and rates of pain-free headache relief at 2 and 24 hours. RESULTS: Two hundred two patients were screened, and 78 of 91 eligible patients were randomized. The two groups had comparable pain scores at baseline. By 2 hours, the change in pain intensity for the metoclopramide group was 7.2 compared with 6.3 for the sumatriptan group (95% CI for difference: -0.2 to 2.2). When compared at 24 hours, the metoclopramide group had improved by 6.1 compared with baseline and the sumatriptan group had improved by 5.0 (95% CI for difference: -0.6 to 2.8). At 2 hours, pain-free rates were 59% in the metoclopramide arm and 35% in the sumatriptan arm (95% CI for difference of 24%: 2 to 46%). The most common side effects at both time points were weakness, dizziness, and drowsiness, which were distributed evenly between the two groups. There were no reports of chest pain within the first 2 hours. The incidence of restlessness, stiffness, and abnormal movements was distributed equally between the two groups. CONCLUSIONS: When compared at 2 and 24 hours, aggressive (20 mg dosed up to four times) IV metoclopramide and 6 mg of subcutaneous sumatriptan relieved migraine headache pain comparably. Some secondary endpoints suggest that metoclopramide may be the preferable therapy for migraines presenting to the emergency department. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/15699376/A_trial_of_metoclopramide_vs_sumatriptan_for_the_emergency_department_treatment_of_migraines_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=15699376 DB - PRIME DP - Unbound Medicine ER -