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Migraine Headache

The following study reviewed metoclopramide as monotherapy in treating migraine headache -“Metoclopramide as a painkiller for intense migraine headache in emergency departments” (Rev Neurol. 2008 Nov 16-30;47(10):506-8).

INTRODUCTION: Migraine headache is an uncommon but disabling clinical entity when patients go to an urgency room with a severe migraine attack and digestive symptoms. Intravenous non-steroidal anti-inflammatory drugs, paracetamol and triptans represent the first line drugs in the migraine therapy in emergency departments elsewhere however the low efficacy and the limitations of the oral way for vomiting determine a difficult situations in some migraine patients. Metoclopramide is an anti-emetic drug which indication in migraine for vomiting and as an adjunctive drug to other analgesic has been reported elsewhere but the analgesic features of this drug in monotherapy has not been largely study in the medical literature.

PATIENTS AND METHODS: We report in this article the clinical features and side effects of 14 patients with severe migraine with digestive symptoms which consecutive came to our urgency department.

RESULTS AND CONCLUSIONS: The patients showed an important improvement after 10 mg of intravenous metoclopramide exclusively with no other analgesic drug. PMID: 19012253

The following review concludes that given its non-narcotic and antiemetic properties, metoclopramide should be considered a primary agent in the treatment of acute migraines -“Parenteral metoclopramide for acute migraine: meta-analysis of randomised controlled trials” (BMJ. 2004 Dec 11;329(7479):1369-73).

OBJECTIVE: To assess the evidence from controlled trials on the efficacy and tolerability of parenteral metoclopramide for acute migraine in adults.

DATA SOURCES: Cochrane Central Register of Controlled Trials, Medline, Embase, LILACS, CINAHL, conference proceedings, clinical practice guidelines, and other sources. SELECTION CRITERIA: Randomised controlled trials of parenteral metoclopramide for acute migraine in adults.

RESULTS: We reviewed 596 potentially relevant abstracts and found 13 eligible trials totaling 655 adults. In studies comparing metoclopramide with placebo, metoclopramide was more likely to provide significant reduction in migraine pain (odds ratio 2.84, 95% confidence interval 1.05 to 7.68). Used as the only agent, metoclopramide showed mixed effectiveness when compared with other single agents. Heterogeneity of studies for combination treatment prevented statistical pooling. Treatments that did include metoclopramide were as, or more, effective than comparison treatments for pain, nausea, and relapse outcomes reported in all studies.

CONCLUSIONS: Metoclopramide is an effective treatment for migraine headache and may be effective when combined with other treatments. Given its non-narcotic and antiemetic properties, metoclopramide should be considered a primary agent in the treatment of acute migraines in emergency departments. PMID: 15550401

We can compound metoclopramide into an intranasal spray. This form of delivery allows for rapid absorption of the medication.

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