Antiemetic also provides pain relief in migraine
Metoclopramide, an antiemetic, effectively reduces headache pain associated with acute migraine and should be considered a primary treatment option in accident and emergency departments, say researchers (BMJ 2004;329:
1369).
They examined data from 13 randomised controlled trials, observing that
as few as four patients need to be treated with the drug to enable one
patient to achieve significant pain reduction. The researchers explain
that metoclopramide has long been used to treat nausea associated with
migraine and that anecdotal reports have indicated it may also have analgesic
properties.
They report that five studies confirmed that metoclopramide is more effective
than placebo for relief of pain and nausea and relapse of headache. Metoclopramide
compared favourably with ibuprofen and sumatriptan in two trials but
three studies suggested it may provide less relief from pain and nausea
than other phenothiazine antiemetics. Several studies showed metoclopramide
combinations were as, or more, effective for pain relief than comparison
regimens (eg, hydroxyzine-meperidine, dihydroergotamine, valproate, ibuprofen,
ketorolac, promethazine-meperidine).
Stroke risk People with a history of migraine appear to be twice
as likely to suffer a stroke than people without migraine. Those
who also use oral contraceptives are at even greater risk. Researchers
looked at data from 11 case-control studies and three cohort studies
and found that the relative risk for ischaemic stroke among patients
with migraine headache was 2.16 (95 per cent confidence interval
1.89 to 2.48). Migraine sufferers who also use oral contraceptives
had an approximately eight-fold increase in risk of stroke compared
with those not using these agents (published on BMJ Online
First,
13 December).
|
|
The
Pharmaceutical Journal
Acrobat
Reader