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Headache. 1993 Nov-Dec;33(10):560-2.

Current emergency treatment of severe migraine headaches.

Author information

1
St. Joseph Hospital, Denver, CO 80218.

Abstract

OBJECTIVE:

To compare the efficacy of the combination of meperidine and hydroxyzine IM, versus dihydroergotamine and metoclopramide IV in the treatment of severe migraine headaches.

DESIGN:

This was a randomized double-blind, double-dummy study.

SETTING:

Established patients, whose headache had failed to respond to their usual abortive agent, were invited to an out-patient headache clinic for the study.

PATIENTS:

Twenty-eight patients, diagnosed as suffering from either migraine headache or chronic daily headache, were screened on arrival to exclude life-threatening causes.

INTERVENTION:

Group A (14 patients) received dihydroergotamine 1mg and metoclopramide 10mg IV and a placebo injection IM, and Group B (14 patients) received meperidine 75mg and hydroxyzine 75mg IM and a placebo injection IV.

MAIN OUTCOME MEASURES:

Patients rated their headaches on a scale of 0-3 prior to treatment and again at 30 and 60 minutes.

RESULTS:

Both groups experienced improvement in headache severity. (Group A P = 0.001 and Group B P = 0.003). Improvement in pain scale score was greater for Group A than Group B. (P = 0.006). The number of patients having a mild or no headache in Group A (13/14) was significantly greater than Group B (3/14). (P < 0.001)

CONCLUSIONS:

The combination of dihydroergotamine and metoclopramide IV should replace the standard IM narcotic and anti-emetic as the parenteral treatment of choice for severe migraine headache.

[Indexed for MEDLINE]

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