A prospective double-blind study of nasal sumatriptan versus IV ketorolac in migraine

Meredith, John T.; Wait, Scott D.; Brewer, Kori L.

doi:10.1016/s0735-6757(02)42256-5

Cited by 61 publications

(53 citation statements)

References 19 publications

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“…Although they have the greatest value early in the course of illness, 24 most children with migraine present to the ED after experiencing prolonged symptoms at home. 5,8 Despite this, studies in adults have shown triptans to be effective as abortive therapy in the ED setting, 25 but there have not been any ED-based pediatric studies. The evidence for pediatric use of triptans in the outpatient setting is strong, [26][27][28][29] yet only 3% of children received a triptan in the current study.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department

2015

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BACKGROUND AND OBJECTIVES: Migraine headache is a common pediatric complaint among emergency department (ED) patients. There are limited trials on abortive therapies in the ED. The objective of this study was to apply a comparative effectiveness approach to investigate acute medication regimens for the prevention of ED revisits. METHODS:Retrospective study using administrative data (Pediatric Health Information System) from 35 pediatric EDs (2009EDs ( -2012. Children aged 7 to 18 years with a principal diagnosis of migraine headache were studied. The primary outcome was a revisit to the ED within 3 days for discharged patients. The primary analysis compared the treatment regimens and individual medications on the risk for revisit. RESULTS:The study identified 32 124 children with migraine; 27 317 (85%) were discharged, and 5.5% had a return ED visit within 3 days. At the index visit, the most common medications included nonopioid analgesics (66%), dopamine antagonists (50%), diphenhydramine (33%), and ondansetron (21%). Triptans and opiate medications were administered infrequently (3% each). Children receiving metoclopramide had a 31% increased odds for an ED revisit within 3 days compared with prochlorperazine. Diphenhydramine with dopamine antagonists was associated with 27% increased odds of an ED revisit compared with dopamine antagonists alone. Children receiving ondansetron had similar revisit rates to those receiving dopamine antagonists. CONCLUSIONS:The majority of children with migraines are successfully discharged from the ED and only 1 in 18 required a revisit within 3 days. Prochlorperazine appears to be superior to metoclopramide in preventing a revisit, and diphenhydramine use is associated with increased rates of return.WHAT'S KNOWN ON THE SUBJECT: Migraine headaches are a common presenting complaint in emergency departments. Abortive treatment in this setting is not well studied, leading to considerable variation in treatment. The relationship between acute medications and emergency department revisits has not been studied. WHAT THIS STUDY ADDS:Eighty-five percent of children with migraine are successfully discharged from the emergency department; only 1 in 18 children require a return visit. Prochlorperazine is associated with less revisits than metoclopramide, and diphenhydramine use is associated with increased risk of return visits.

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Section: Discussionmentioning

confidence: 99%

A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department

2015

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“…In a randomized study not included in the meta-analysis, Friedman et al, reported similar findings in regards to the effectiveness of ketorolac in managing migraine headaches-a decrease in pain scale scores of 3.9 units (Friedman et al, 2014). Meredith et al, compared the effectiveness of sumatriptan and ketorolac on emergency department migraine management, finding the latter to be more effective (Meredith et al, 2003).…”

Section: Discussionmentioning

confidence: 81%

Intravenous caffeine versus intravenous ketorolac for the management of moderate to severe migraine headache

Baratloo

Bafarani

Forouzanfar

et al. 2016

Bangladesh J Pharmacol

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<p class="Abstract">The aim of this study was to determine if intravenous caffeine is as effective as intravenous ketorolac for the treatment of moderate to severe migraine headaches. Eligible patients randomly received 60 mg caffeine citrate or 60 mg ketorolac infused intravenously. Their pain score were measured at baseline, one hour and two hours after infusion. Therapeutic success was defined as decreasing of at least 3 points on the pain score. In total 110 patients were enrolled (75.5% women). Therapeutic success after 60 min was achieved by 63.6% of patients in the caffeine and 70.1% of patients in the ketorolac group (p = 0.23). After 120 min, 87.3% of the caffeine group and 83.6% of the ketorolac group achieved therapeutic success (p = 0.49). In this multi-center, randomized double blind study, intravenous caffeine was as effective as intravenous ketorolac for first line abortive management of acute migraine.</p><p> </p>

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“…Intravenous ketorolac was compared with nasal sumatriptan in a prospective double-blind study that performed on patients with complaint of migraine headache. Authors reported that although both drugs significantly reduced the pain, but intravenous ketorolac was more effective than nasal sumatriptan in this regard (21). In a controlled trial, intramuscular ketorolac was compared with meperidine plus promethazine, and also normal saline as a placebo in tension headache.…”

Section: Discussionmentioning

confidence: 99%

Efficacy measurement of ketorolac in reducing the severity of headache

Baratloo

Amiri

Mehdi

et al. 2015

Journal of Emergency Practice and Trauma

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Objective: One of nonsteroidal anti-inflammatory drugs (NSAIDs) named as ketorolac is frequently used to relieve acute pain. Current study was conducted with the aim of ketorolac efficacy measurement as a pain killer agent for controlling the primary headache in emergency departments. Methods: In this study, we enrolled 50 patients with primary headache who received 60 mg ketorolac intravenously as a slow infusion in about 10 minutes. Pain scores were evaluated with visual analog scale (VAS) on arrival and also 1 hour and 2 hours after ketorolac infusion. Statistical analysis was performed on collected data by using Wilcoxon and Mann-Whitney tests to assess the differences in VAS pain scores. Results: Decreasing the VAS more than 3 points from the arrival until 1 hour (P < 0.001), and more than 5 points from the arrival until 2 hours after ketorolac administration (P < 0.001) were seen. Those with history of analgesic use before admission in emergency department in comparison with the others did not accompany with more decline in pain score after 1 hour (P = 0.34) or 2 hours (P = 0.92). Conclusion: It seems that ketorolac is assured, safe and well tolerated agent for pain control in patients presented with primary headache to the emergency departments. Based on the results achieved in this study, ketorolac illustrates its perceptible effects within 1 hour after administration that even more prominent after 2 hours.

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A prospective double-blind study of nasal sumatriptan versus IV ketorolac in migraine

Cited by 61 publications

References 19 publications

A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department

A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department

Intravenous caffeine versus intravenous ketorolac for the management of moderate to severe migraine headache

Efficacy measurement of ketorolac in reducing the severity of headache

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