Comparison of Therapeutic Effects of Magnesium Sulfate vs. Dexamethasone/Metoclopramide on Alleviating Acute Migraine Headache

Shahrami, Ali; Assarzadegan, Farhad; Hatamabadi, Hamid Reza; Asgarzadeh, Morteza; Sarehbandi, Baharak; Asgarzadeh, Setareh

doi:10.1016/j.jemermed.2014.06.055

Cited by 44 publications

(66 citation statements)

References 35 publications

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“…23,26,35 RoB from randomization method was unclear for the remaining 4 studies. 23,26,35 RoB from randomization method was unclear for the remaining 4 studies.…”

Section: Description Ofmentioning

confidence: 99%

“…21,22,27,28 Blinding (Performance Bias and Detection Bias).-Six studies were double blind, 22,23,[26][27][28]35 and 4 were placebo controlled (normal saline). 21 Incomplete Outcome Data (Attrition Bias).-Five studies reported that no patient attrition occurred, 21,[26][27][28]35 whereas 2 studies reported that patient attrition occurred. 21 Incomplete Outcome Data (Attrition Bias).-Five studies reported that no patient attrition occurred, 21,[26][27][28]35 whereas 2 studies reported that patient attrition occurred.…”

Section: Description Ofmentioning

confidence: 99%

“…¶Placebo plus metoclopramide (22, 96%) group performed better than the magnesium sulfate plus metoclopramide (15, 71%). 35 One study assessed for a 50% reduction in pain scores, 26 while 2 assessed for complete symptom resolution. † †Placebo plus metoclopramide (17, 74%) group performed better than the magnesium sulfate plus metoclopramide (8, 38%).…”

Section: Description Ofmentioning

confidence: 99%

“…The difference between groups was 36 (95% CI 7-65). 21,22,[26][27][28]35 One study was scored as unclear because the statistical tests used were not described. The mean pain reduction was greater for prochlorperazine than for magnesium sulfate (47 mm vs 24 mm, t = 0.208, P = .045).…”

Section: Description Ofmentioning

confidence: 99%

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Intravenous Magnesium Sulfate to Treat Acute Headaches in the Emergency Department: A Systematic Review

et al. 2019

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Introduction Non‐traumatic headaches comprise up to 4% of all emergency department (ED) visits. Current practice is moving toward multimodal analgesia regimens that limit narcotic use. Objective The objective of this systematic review is to address the following research question: In patients with non‐traumatic headaches (Population), does administration of intravenous magnesium sulfate (Intervention) compared to placebo, corticosteroids, dopamine antagonists, ergot alkaloids, non‐steroidal anti‐inflammatory drugs (NSAIDs), triptans, or usual care result in better pain control, lower rate of recurrence at 24 hours, lower requirements for rescue analgesia, and less adverse medication effects (Outcomes)? Methods Scholarly databases and relevant bibliographies were searched, as were clinical trial registries and relevant conference proceedings to limit publication bias. Studies were not limited by date, language, or publication status. Inclusion criteria were: (1) randomized clinical trial (RCT), (2) patients age ≥18 years, (3) non‐traumatic headache, (4) patients treated in ED or an outpatient acute care treatment center, and (5) magnesium sulfate administered intravenously (IV). Eligible comparison groups included: placebo, conventional therapy, dopamine antagonist, NSAID, corticosteroid, ergot alkaloid, or triptans. Results Out of 4018 identified references, 7 RCTs (545 participants) that treated migraine headaches (n = 6) and benign non‐traumatic headaches (n = 1) met inclusion criteria. Pain intensity was improved with magnesium sulfate vs comparators at 60‐120 minutes, but not at earlier time points. Result for the endpoint of pain reduction by 50% were conflicting as 3 studies reported that headache was improved, unchanged, and less with magnesium sulfate. Complete pain relief was improved with magnesium sulfate in 1 study, and in the migraine with aura (MA) subgroup in another. The need for rescue analgesia at any point was improved with magnesium sulfate in 1 study, and in the MA subgroup in another. Twenty‐four‐hour headache recurrence was improved with magnesium sulfate in 1 study, but unchanged in a second. The intended meta‐analysis was not performed due to the clinical heterogeneity among studies. Conclusion While we cannot draw a firm conclusion on the efficacy or benefit of intravenous magnesium sulfate in the treatment of acute non‐traumatic headaches, the existing evidence indicates potential benefits in pain control beyond 1 hour, aura duration, and need for rescue analgesia.

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“…23,26,35 RoB from randomization method was unclear for the remaining 4 studies. 23,26,35 RoB from randomization method was unclear for the remaining 4 studies.…”

Section: Description Ofmentioning

confidence: 99%

Section: Description Ofmentioning

confidence: 99%

Section: Description Ofmentioning

confidence: 99%

Section: Description Ofmentioning

confidence: 99%

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Intravenous Magnesium Sulfate to Treat Acute Headaches in the Emergency Department: A Systematic Review

et al. 2019

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“…Pain intensity was measured using a 10-point visual analog pain scale prior to medical intervention and then 60 and 120 min post medical intervention. The 120 min endpoint was chosen based on similar previous clinical trials, where 120 min was found to be standard (Coppola et al, 1995;Shahrami et al, 2015). Our primary outcome was therapeutic efficacy, which was defined as an improvement in three points on the visual analog scale without requirement of rescue medication.…”

Section: Outcome Measuresmentioning

confidence: 99%

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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Acute Treatments for Episodic Migraine in Adults

VanderPluym

Singh

Urtecho

et al. 2021

JAMA

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IMPORTANCEMigraine is common and can be associated with significant morbidity, and several treatment options exist for acute therapy.OBJECTIVE To evaluate the benefits and harms associated with acute treatments for episodic migraine in adults.DATA SOURCES Multiple databases from database inception to February 24, 2021.STUDY SELECTION Randomized clinical trials and systematic reviews that assessed effectiveness or harms of acute therapy for migraine attacks.DATA EXTRACTION AND SYNTHESIS Independent reviewers selected studies and extracted data. Meta-analysis was performed with the DerSimonian-Laird random-effects model with Hartung-Knapp-Sidik-Jonkman variance correction or by using a fixed-effect model based on the Mantel-Haenszel method if the number of studies was small. MAIN OUTCOMES AND MEASURESThe main outcomes included pain freedom, pain relief, sustained pain freedom, sustained pain relief, and adverse events. The strength of evidence (SOE) was graded with the Agency for Healthcare Research and Quality Methods Guide for Effectiveness and Comparative Effectiveness Reviews.FINDINGS Evidence on triptans and nonsteroidal anti-inflammatory drugs was summarized from 15 systematic reviews. For other interventions, 115 randomized clinical trials with 28 803 patients were included. Compared with placebo, triptans and nonsteroidal anti-inflammatory drugs used individually were significantly associated with reduced pain at 2 hours and 1 day (moderate to high SOE) and increased risk of mild and transient adverse events. Compared with placebo, calcitonin gene-related peptide receptor antagonists (low to high SOE), lasmiditan (5-HT 1F receptor agonist; high SOE), dihydroergotamine (moderate to high SOE), ergotamine plus caffeine (moderate SOE), acetaminophen (moderate SOE), antiemetics (low SOE), butorphanol (low SOE), and tramadol in combination with acetaminophen (low SOE) were significantly associated with pain reduction and increase in mild adverse events. The findings for opioids were based on low or insufficient SOE. Several nonpharmacologic treatments were significantly associated with improved pain, including remote electrical neuromodulation (moderate SOE), transcranial magnetic stimulation (low SOE), external trigeminal nerve stimulation (low SOE), and noninvasive vagus nerve stimulation (moderate SOE). No significant difference in adverse events was found between nonpharmacologic treatments and sham.CONCLUSIONS AND RELEVANCE There are several acute treatments for migraine, with varying strength of supporting evidence. Use of triptans, nonsteroidal anti-inflammatory drugs, acetaminophen, dihydroergotamine, calcitonin gene-related peptide antagonists, lasmiditan, and some nonpharmacologic treatments was associated with improved pain and function. The evidence for many other interventions, including opioids, was limited.

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Comparison of Therapeutic Effects of Magnesium Sulfate vs. Dexamethasone/Metoclopramide on Alleviating Acute Migraine Headache

Cited by 44 publications

References 35 publications

Intravenous Magnesium Sulfate to Treat Acute Headaches in the Emergency Department: A Systematic Review

Intravenous Magnesium Sulfate to Treat Acute Headaches in the Emergency Department: A Systematic Review

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

Acute Treatments for Episodic Migraine in Adults

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