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Parenteral Drug Treatments for Acute Migraine Headache

Technical Reviews, No. 2.5

Contributing Authors: , DPhil, , MD, MHSc, , BA, , MD, and , PhD.

Center for Clinical Health Policy Research, Duke University

Structured Abstract


To identify and summarize evidence from controlled trials on the efficacy and tolerability of parenteral drug treatments for acute migraine headache.

Search strategy:

A strategy combining the MeSH term “headache” (exploded) and a previously published strategy for identifying randomized controlled trials was on the January 1966 to December 1996 MEDLINE database. Other computerized bibliographic databases, textbooks, and experts were also utilized.

Selection criteria:

English-language controlled trials involving patients with acute migraine headache in which at least one treatment offered was a parenterally administered drug treatment were selected. Subcutaneous treatments delivered with an autoinjector designed for self-administration are considered in a companion report.

Data collection and analysis:

The number of patients obtaining headache relief according to an a priori definition of at least a 50% reduction in pain severity was recorded and used to calculate odds ratios for headache relief. Measures of pain severity reported as group means (and standard deviations) were used to calculate standardized mean differences (or effect sizes). Where similar trials provided data, meta-analysis of efficacy measures was performed.

Main results:

Controlled trials provide limited support for the efficacy of a number of parenteral treatments, including antinauseants (prochlorperazine and metoclopramide), NSAIDs (diclofenac), and opiate analgesics (butorphanol and methadone). Weaker evidence supports the efficacy of dihydroergotamine (DHE). The principal adverse effects observed were nausea (DHE and opiates) and sedation (opiates and antinauseants).


Several parenteral drugs appear to be effective for the treatment of acute migraine. The evidence supporting their efficacy is, however, limited by the small number of placebo comparisons; the small size of most trials; and the diversity of settings, diagnostic criteria, and outcome measures used. The inconclusive comparisons among classes of drugs and individual agents suggest that the choice among parenteral alternatives for the treatment of acute migraine may, for the present, depend more on side effects and contraindications than on data about efficacy.

Project Directors: Douglas C McCrory, MD, MHSc, David B Matchar, MD. Project Manager: Rebecca N Gray, DPhil. Research Assistants: Louise Nobles, RN, Susan Farese, RN, Pramod Gumpeni, BA. Technical Advisors: Jay Rosenberg, MD, Stephen Silberstein, MD, Seymour Solomon, MD, William Young, MD, James Adelman, MD, David Buchholz, MD, David Capobianco, MD, Debra Elliott, MD, David Kudrow, MD, Ninan Mathew, MD, Lawrence Newman, MD, Nabih Ramadan, MD, Carl Sadowsky, MD, Elliott Schulman, MD, Stewart Tepper, MD, Paul Winner, MD. AHCPR Project Officer: Ernestine Murray, RN, MAS.

Prepared for: Agency for Health Care Policy and Research, Department of Health and Human Services, U.S. Public Health Service, Rockville, Maryland. Contract No. 290-94-2025. Prepared by: Center for Clinical Health Policy Research, Duke University.

Suggested citation:

Duke University, Center for Clinical Health Policy Research. Parenteral Drug Treatments for Acute Migraine Headache. Technical Review 2.5. February 1999. (Prepared for the Agency for Health Care Policy and Research under Contract No. 290-94-2025. Available from the National Technical Information Service; NTIS Accession No. PB99-127862.)

This document does not necessarily represent the views of the Department of Health and Human Services. It is available from the National Technical Information Service at 1-800-553-6847.

Bookshelf ID: NBK45277PMID: 20734518


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