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Current Emergency Treatment of Severe Migraine Headaches
Author(s) -
Klapper Jack A.,
Stanton John
Publication year - 1993
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/j.1526-4610.1993.hed3310560.x
Subject(s) - headaches , migraine , medicine , current (fluid) , emergency treatment , intensive care medicine , medical emergency , anesthesia , psychiatry , engineering , electrical engineering
SYNOPSIS 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 s 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 antiemetic as the parenteral treatment of choice for severe migraine headache.