In patients with acute migraine, intravenous metoclopramide is nonsuperior to placebo with regard to safety and its effects on reducing the intensity of headache, according to study results published in Acta Neurologica Scandinavica.
Patients who presented to the emergency department with migraine-type headaches were enrolled. Investigators randomly assigned participants to either 10 mg intravenous metoclopramide in 100 mL normal saline solution (n=74) or intravenous normal 100 mL saline solution placebo (n=74). Participants remained in a silent, darkened room in the emergency department during the study protocol. The 11-point Numeric Rating Scale (NRS) score was used to assess participants’ headache intensity at presentation (baseline) and at 15 and 30 minutes after infusion. In addition to assessment of the NRS score, the researchers also evaluated changes in headache intensity approximately 24 to 72 hours after discharge.
At baseline, the median NRS score was 8 (interquartile range [IQR], 7-10) in both groups, representing a relatively high headache intensity (maximum, 11). Similar reductions were observed in the metoclopramide and placebo groups with regard to the median NRS scores at 15 minutes of infusion (6 [IQR, 4-7] and 6 [IQR, 5-8], respectively) and 30 minutes of infusion (3 [IQR, 1-5] and 5 [IQR, 2-7], respectively). No difference was observed between active treatment and control in terms of the difference between baseline median NRS and 30-minute median NRS (4 [IQR, 2-6] and 3 [IQR, 1-4], respectively; median difference, −1.0; 95% CI, −2.1 to 0.1). The rate of adverse events was 5.4% in both groups, and no difference was observed between metoclopramide and placebo with regard to the proportion of patients who required rescue medication (21.6% vs 36.5%, respectively; difference, −14.9%; 95% CI, −32.0 to 2.5).
Limitations of the study included its small patient population, the use of a telephone survey for obtaining follow-up data, the performance of the study at a single center, and the short follow-up duration.
The researchers explained that “the high treatment failure and necessity for rescue drugs in the metoclopramide group may have been due to the intramuscular administration of the drugs and related to the delayed effects.”
Doğan NÖ, Pekdemir M, Yılmaz S, et al. Intravenous metoclopramide in the treatment of acute migraines: A randomized, placebo-controlled trial [published online January 10, 2019]. Acta Neurol Scand. doi: 10.1111/ane.13063