Researchers from the University of Alberta, University of Cambridge, Michigan State University and British Columbia's St. Paul's Hospital are recommending metoclopramide be considered a primary step in treating migraine sufferers who visit the emergency room for treatment.
The medication differs from traditional approaches such as narcotics (morphine or Demerol), because it avoids the risk of addiction to painkillers, noted Dr. Brian Rowe, a professor of emergency medicine at the University of Alberta.
"There is a tendency for patients with migraines to become dependent on narcotics for acute pain relief. Unfortunately, narcotics may reduce the pain acutely, however, they are sedating, usually with adverse effects, are usually not very effective and many patients suffer headache relapses that result in returns to the emergency room for additional care," Dr. Rowe said. "We recommend metoclopramide because it is safe, inexpensive and leads to less dependence on narcotics."
While metoclopramide has previously been used to treat migraines, the evidence was conflicting and this review by Rowe and his fellow researchers has helped clarify approaches for adult patients seeking headache relief in an emergency setting.
Results of the study, which involved reviewing data from 13 trials involving 655 adults, were published this month in the British Medical Journal. In studies comparing metoclopramide with placebos, the medication was 2.8 times more likely to provide significant reduction in migraine. In addition, combination treatments that included metoclopramide were as, or more effective than comparison treatments for migraine pain, nausea and relapse outcomes reported in all studies reviewed by the researchers.
Administered intravenously, metoclopramide proved effective in relieving the nausea that often accompanies a migraine, worked rapidly, was gentle on the stomach and did not cause changes in blood pressure.
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