Rescue therapy for acute migraine, part 3: opioids, nsaids, steroids, and post-discharge medications

Headache: The Journal of Head and Face Pain, 03/23/2012

The overall percentage of patients with pain relief after taking sumatriptan was equivalent to that observed with droperidol or prochlorperazine.

Methods

  • Using the terms (“migraine” AND “emergency”) AND (“therapy” OR “treatment”), the author searched MEDLINE for reports from ED and urgent care settings that involved all routes of medication delivery.
  • Reports from headache clinic settings were included only if medications were delivered by a parenteral route.

Results

  • Seventy–five reports were identified that compared the efficacy and safety of multiple acute migraine medications for rescue.
  • Of the medications reviewed in Part 3, opioids, NSAIDs, and steroids all demonstrated some effectiveness.
  • When used alone, nalbuphine and metamizole were superior to placebo.
  • NSAIDs were inferior to the combination of metoclopramide and diphenhydramine.
  • Meperidine was arguably equivalent when compared with ketorolac and dihydroergotamine (DHE) but was inferior to chlorpromazine and equivalent to the other dopamine antagonists.
  • Steroids afford some protection against headache recurrence after the patient leaves the treatment center. /li>

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