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The results of 2 large field studies on the impact of the polio eradication initiative on health systems and 3 supplementary reports were presented at a December 1999 meeting convened by the World Health Organization. All of these studies concluded that positive synergies exist between polio eradication and health systems but that these synergies have not been vigorously exploited. The eradication of polio has probably improved health systems worldwide by broadening distribution of vitamin A supplements, improving cooperation among enterovirus laboratories, and facilitating linkages between health workers and their communities. The results of these studies also show that eliminating polio did not cause a diminution of funding for immunization against other illnesses. Relatively little is known about the opportunity costs of polio eradication. Improved planning in disease eradication initiatives can minimize disruptions in the delivery of other services. Future initiatives should include indicators and baseline data for monitoring effects on health systems development.

SUMMARY One hundred and fifty patients with migraine attacks attending the Copenhagen acute migraine clinic were treated either with metoclopramide 10 mg i.m., metoclopramide 20 mg as suppository or placebo in a double blind trial. All patients simultaneously or 30 minutes later received paracetamol lg and diazepam 5 mg orally. The nausea was relieved in 71 % of the patients by placebo and bed rest, but metoclopramide was significantly (p=004) more effective and relieved nausea in 86% of the patients. Metoclopramide did not by itself reduce the pain, but enhanced the effect of the analgesic or sedative medication. This effect, however, just failed to be statistically significant (p=006) Nausea, vomiting and delayed absorption of analgesics due to gastric stasis are usual features of the acute migraine attack. Phenothiazine-like drugs have most often been used as antiemetics, but they have anticholinergic effects, which could counteract gastric emptying.' It has been shown that metoclopramide is an effective antiemetic.2 At the same time it promotes emptying of the stomach and normalises the absorption of aspirin during migraine attacks.3 Based on this twofold rationale metoclopramide has been introduced as a supplement to analgesics in the treatment of the acute migraine attack.5 We have conducted a double blind trial with metoclopramide in 150 patients suffering from acute migraine attacks. The study was conducted in an acute migraine clinic, where the patients could be observed throughout the attack. Our aim was to evaluate the effect on nausea and to see if metoclopramide increased the effectiveness of the analgesic-sedative treatment with paracetamol and diazepam. Patients and methodsThe trial involved 150 patients with classical or