OBJECTIVE: To compare the efficacy of the combination of meperidine and hydroxyzine IM, versus dihydroergotamine and metoclopramide IV in the treatment of severe migraine headaches. DESIGN: This was a randomized double-blind, double-dummy study. SETTING:Established patients, whose headache had failed to respond to their usual abortive agent, were invited to an out-patient headache clinic for the study. PATIENTS: Twenty-eight patients, diagnosed as suffering from either migraine headache or chronic daily headache, were screened on arrival to exclude life-threatening causes. INTERVENTION: Group A (14 patients) received dihydroergotamine 1mg and metoclopramide 10mg IV and a placebo injection IM, and Group B (14 patients) received meperidine 75mg and hydroxyzine 75mg IM and a placebo injection IV. MAIN OUTCOME MEASURES: Patients rated their headaches on a scale of 0-3 prior to treatment and again at 30 and 60 minutes. RESULTS: Both groups experienced improvement in headache severity. (Group A P = 0.001 and Group B P = 0.003). Improvement in pain scale score was greater for Group A than Group B. (P = 0.006). The number of patients having a mild or no headache in Group A (13/14) was significantly greater than Group B (3/14). (P < 0.001) CONCLUSIONS: The combination of dihydroergotamine and metoclopramide IV should replace the standard IM narcotic and anti-emetic as the parenteral treatment of choice for severe migraine headache.
RCT Entities:
OBJECTIVE: To compare the efficacy of the combination of meperidine and hydroxyzine IM, versus dihydroergotamine and metoclopramide IV in the treatment of severe migraine headaches. DESIGN: This was a randomized double-blind, double-dummy study. SETTING: Established patients, whose headache had failed to respond to their usual abortive agent, were invited to an out-patientheadache clinic for the study. PATIENTS: Twenty-eight patients, diagnosed as suffering from either migraineheadache or chronic daily headache, were screened on arrival to exclude life-threatening causes. INTERVENTION: Group A (14 patients) received dihydroergotamine 1mg and metoclopramide 10mg IV and a placebo injection IM, and Group B (14 patients) received meperidine 75mg and hydroxyzine 75mg IM and a placebo injection IV. MAIN OUTCOME MEASURES: Patients rated their headaches on a scale of 0-3 prior to treatment and again at 30 and 60 minutes. RESULTS: Both groups experienced improvement in headache severity. (Group A P = 0.001 and Group B P = 0.003). Improvement in pain scale score was greater for Group A than Group B. (P = 0.006). The number of patients having a mild or no headache in Group A (13/14) was significantly greater than Group B (3/14). (P < 0.001) CONCLUSIONS: The combination of dihydroergotamine and metoclopramide IV should replace the standard IM narcotic and anti-emetic as the parenteral treatment of choice for severe migraineheadache.
Authors: Benjamin W Friedman; Alok Kapoor; Matt S Friedman; Michael L Hochberg; Brian H Rowe Journal: Ann Emerg Med Date: 2008-07-16 Impact factor: 5.721