| Rescue therapy for acute migraine, part 2: neuroleptics, antihistamines, and others. | |
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MedLine Citation:
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PMID: 22309235 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Objectives.- This second portion of a 3-part series examines the relative effectiveness of headache treatment with neuroleptics, antihistamines, serotonin antagonists, valproate, and other drugs (octreotide, lidocaine, nitrous oxide, propofol, and bupivacaine) in the setting of an emergency department, urgent care center, or headache clinic. Methods.- MEDLINE was searched using the terms "migraine" AND "emergency" AND "therapy" OR "treatment." Reports were from emergency department and urgent care settings and involved all routes of medication delivery. Reports from headache clinics were only included if medications were delivered by a parenteral route. Results.- Prochlorperazine, promethazine, and metoclopramide, when used alone, were superior to placebo. Droperidol and prochlorperazine were superior or equal in efficacy to all other treatments, although they also have more side effects (especially akathisia). Metoclopramide was equivalent to prochlorperazine and, when combined with diphenhydramine, was superior in efficacy to triptans and non-steroidal anti-inflammatory drugs. Meperidine was inferior to chlorpromazine and equivalent to the other neuroleptics. The overall percentage of patients with pain relief after taking droperidol and prochlorperazine was equivalent to sumatriptan. Conclusions.- Prochlorperazine and metoclopramide are the most frequently studied of the anti-migraine medications in the emergent setting, and the effectiveness of each is superior to placebo. Prochlorperazine is superior or equivalent to all other classes of medications in producing migraine pain relief. Dopamine antagonists, in general, appear to be equivalent for migraine pain relief to the migraine-"specific" medications sumatriptan and dihydroergotamine, although there are fewer studies involving the last two. Lack of comparisons to placebo and the frequent use of combination medications in treatment arms complicate the comparison of single agents to one other. |
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Authors:
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Nancy E Kelley; Deborah E Tepper |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Headache Volume: 52 ISSN: 1526-4610 ISO Abbreviation: Headache Publication Date: 2012 Feb |
Date Detail:
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Created Date: 2012-02-07 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 2985091R Medline TA: Headache Country: United States |
Other Details:
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Languages: eng Pagination: 292-306 Citation Subset: IM |
Copyright Information:
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© 2012 American Headache Society. |
Affiliation:
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From the Center for Headache and Pain, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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