Metoclopramide vs Sumatriptan: Which Is More Effective for Reducing Headaches?

A significant decrease in headache scores was seen with the administration of intravenous (IV) metoclopramide, compared with placebo and sumatriptan, according to the findings of a study published in the journal BMC Neurology. 

Migraine has long been treated with various pain relievers, making it crucial to determine which medication is the most effective. Researchers conducted a network meta-analysis to determine the efficacy, side effects, and migraine recurrence of metoclopramide, compared with other migraine medications. 

The researchers collected data from Scopus, PubMed, Web of Science, and Cochrane Library from inception to June 2022. All clinical trials investigating the effects of metoclopramide alone, compared with a placebo or another active antimigraine drug, were included in the study. 

Studies that combined metoclopramide with other active medications were excluded from the analysis. All modes of administration of metoclopramide were included in the analysis 

The antimigraine medications considered for inclusion were:

• prochlorperazine,
• chlorpromazine,
• ketorolac,
• valproate,
• sumatriptan,
• bupivacaine,
• granisetron,
• dexketoprofen trometamol,
• dexamethasone,
• magnesium sulfate,
• pethidine, and
• ibuprofen.

The primary study outcome was a change in headache status and complete relief from headaches. The secondary outcomes were the use of headache rescue medications, recurrence of attacks, nausea relief, and adverse drug reactions. 

The literature search yielded 3,352 results and 16 randomized clinical trials were included in the analysis. There were 1,934 patients in total, with 826 receiving metoclopramide and individuals in the control group receiving either placebo (302 patients) or different medications (806 patients).

A total of 8 studies compared metoclopramide with placebo and 13 studies compared metoclopramide with other active medications. There were 14 studies using the standard intravenous (IV) dose of 10 mg metoclopramide and 2 studies used an intramuscular (IM) dose of 10 mg metoclopramide. One study used 20 mg IV metoclopramide and another used 20 mg IM metoclopramide. Lastly, 1 study used 0.1 mg/ kg IV of metoclopramide.

Among the 4 studies measuring headache scores at 15 minutes, the researchers determined that 10 mg of IV metoclopramide had a more significant decrease in headache scores, compared with 6 mg of subcutaneous (SQ) sumatriptan. Headache scores measured at 30 minutes and 1-hour showed that metoclopramide had significantly improved headache scores compared with placebo and 600 mg of ibuprofen. 

The meta-analysis revealed that the overall mean difference was in favor of metoclopramide, compared with placebo in 2 studies (standardized mean difference [SMD], -0.63; 95% CI, -0.88 to -0.37; P <.00001). However, metoclopramide compared with chlorpromazine in 2 studies showed that the overall mean difference did not favor either group (SMD, 0.25; 95% CI, -0.07 to 0.56; P <.13).

A meta-analysis was conducted comparing metoclopramide with placebo between 30 minutes to 1-hour and results significantly favored metoclopramide (odds ratio [OR], 0.28; 95% CI, 0.19-0.43; P <.00001). However, when comparing metoclopramide with prochlorperazine, results significantly favored prochlorperazine (OR, 3.02; 95% CI, 1.15-7.94; P =.03).

Overall, metoclopramide can reduce headache outcomes for up to 24 hours. The IV route of administration was used most and yielded positive results for headache outcomes. Both 10 mg and 20 mg doses of metoclopramide showed improvement of headache outcomes but were not directly compared.

“Our study presents a comprehensive review of metoclopramide use in migraine,” the researchers noted. They concluded, “All of these findings may consider metoclopramide to be one of the first-line treatments to decrease acute migraine attacks in the emergency department.”

Study limitations are a small number of studies comparing metoclopramide to other drugs to conduct a direct meta-analysis and high study heterogeneity.