Table 48Summary of the strength of evidence for the effectiveness of opioids versus placebo or an active treatment (Key Question 1)

OutcomeComparison (# Studies)Strength of EvidenceSummary
Pain intensity–VASOpioids vs. placebo (3 RCTs)ModerateSignificant effect in favor of opioids
(MD = −16.73; 95% CI: −24.12, −9.33; I2= 0%)
Pain intensity–VASNalbuphine vs. nalbuphine + hydroxyzine (1RCT)InsufficientNo significant difference between groups
(MD = −15.80; 95% CI: −32.66, 1.06)
Pain intensity–VASButorphanol vs meperidine + hydroxyzine (1 RCT)InsufficientSignificant effect in favor of Butorphanol
(MD = −17.00; 95% CI: −31.41, −2.59)
Pain intensity- VASDHE vs. meperidine (1 RCT)InsufficientNo significant difference between groups
(MD = −2.20; 95% CI: −10.03, 14.43)
Pain responseDiclofenac vs. tramadol (1 RCT)InsufficientNo significant difference between groups
(RR = 1.0; 95% CI: 0.73, 1.36)
Pain free (1–2 hrs)Diclofenac vs. tramadol (1 RCT)InsufficientNo significant difference between groups
(RR = 1.29; 95% CI: 0.60, 2.77)
Headache recurrenceDiclofenac vs. tramadol (1 RCT)InsufficientNo significant difference between groups
(RR = 1.50; 95% CI: 0.28, 8.04)
Change in pain- VASKetorolac vs. meperidine + promethazine (1 RCT)InsufficientNo significant difference between groups
(MD = 0.00; 95% CI: −7.51, 7.51)
Pain responseKetorolac vs. meperidine + promethazine (1 RCT)InsufficientNo significant difference between groups
(RR = 0.81; 95% CI: 0.49, 1.31)
Change in pain- VASKetorolac vs. meperidine + hydroxyzine (1 RCT)InsufficientNo significant difference between groups
(MD = 5.20; 95% CI: −10.08, 20.48)
Pain responseKetorolac vs. meperidine (1 RCT)InsufficientNo significant difference between groups
(RR = 0.53; 95% CI: 0.24, 1.20)
Pain free (1–2 hrs)Ketorolac vs. meperidine (1 RCT)InsufficientNo significant difference between groups
(RR = 0.21; 95% CI: 0.03, 1.62)
Pain intensity–VASNalbuphine vs hydoxyzine (1 RCT)InsufficientNo significant difference between groups
(MD = −17.70; 95% CI: −36.85.14,1.45)
Pain intensity–VASNalbuphine + hydroxyzine vs. Hydroxyzine (1 RCT)InsufficientNo significant difference between groups
(MD = −1.90; 95% CI: −18.92, 15.12)
Pain intensity–VASMeperidine + dimenhydrinate vs methotrimeprazine (1 RCT)InsufficientNo significant difference between groups
(MD = 15.0; 95% CI: −2.75, 32.75)
Change in pain- VASMethotrimeprazine vs. meperidine + dimenhydrinate (1 RCT)InsufficientNo significant difference between groups
(MD = 6.30; 95% CI: −4.77, 17.37)
Pain intensity–VASMorphine vs dexamethasone (1 RCT)InsufficientSignificant effect in favor of morphine
(MD = −8.20; 95% CI: −12.58, −3.82)
Change in pain- VASDroperidol vs. meperidine (1 RCT)InsufficientNo significant difference between groups
(MD = −10.0; 95% CI: −30.03, 10.03)
Change in pain- VASChlorpromazine vs. meperidine + dimenhydrinate 1 RCT)InsufficientSignificant effect in favor of chlorpromazine
(MD = −26.1; 95% CI: −40.1, −12.1)

CI = confidence interval; DHE = dihydroergotamine; MD = mean difference; RCT = randomized controlled trial; RR = risk ratio; VAS = visual analog scale

From: Summary and Discussion

Cover of Acute Migraine Treatment in Emergency Settings
Acute Migraine Treatment in Emergency Settings [Internet].
Comparative Effectiveness Reviews, No. 84.
Sumamo Schellenberg E, Dryden DM, Pasichnyk D, et al.

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