Clinical Question: In patients with...

Clinical Question: In patients with acute migraine, is metoclopramide, alone or in combination with other migraine medications, effective in diminishing pain and nausea?

Setting: crisis department

Study Design: Systematic review

Synopsis: Metoclopramide was used originally to treat nausea caused on gastric stasis associated with acute migraine, as well as to enhance absorption of orally administered remedys Subsequent studies showed relief of pain with the use of metoclopramide alone. In this meta-analysis, investigators gathered 13 randomized controll trials from 596 potentially relevant studies that were identified from a search of several databases and sources. These studies evaluated the use of parenteral 10-mg metoclopramide to treat acute migraine in adults in pressing necessity departments or headache clinics. The search was thorough and included an attempt to find unpublished research. The articles were disguiseed by two independent reviewers to determine whether they met inclusion criteria.

Compared with placebo in five small studies enrolling 185 patients, metoclopramide produc significant reductions in headache pain, although the general intent was not consistent (number povertyed to treat = four; 95 percent confidence interval, 21 to 951) Compared with other antiemetics, metoclopramide was as effective--or nearly so--in reducing headache pain and nausea (the consideration results could not be combined). In 40 patients, metoclopramide was as effective as sumatriptan in the rate of integral pain resolution, significant pain reduction, and the likelihood of nausea reduction. The combination of metoclopramide and dihydroergotamine was more effective than dihydroergotamine alone, valproate, meperidine/hydroxyzine, ketorolac, and prometh-azine/meperidine. Drowsiness, restlessnes and dizziness were reported with the use of metoclopramide.

Bottom Line: Parenteral 10-mg metoclopramide is somewhat effective when used alone and have the appearances to add to relief when used with other migraine treatments. Given its relatively gentle cost and its two-pronged general intent on pain and nausea, it should be considered in patients with acute migraine. (Level of Evidence: 1a)

thought Reference: Colman I, et al. Parenteral metoclopramide for acute migraine: meta-analysis of randomised controll trials. BMJ December 11 2004;329:1369-73 Used with permission from Shaughnessy AF. Metoclopramide (Reglan) effective in migraine. Accessed online March 1 2005 at: http://www.InfoPOEMs.com.

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