I-FiBH trial: intravenous fluids in benign headaches—a randomised, single-blinded clinical trial

Zitek, Tony; Sigal, T.; Sun, Gina H.; Manuel, Chris Martin; Tran, Khanhha

doi:10.1136/emermed-2019-209389

Cited by 3 publications

(3 citation statements)

References 24 publications

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“…IV fluids are often given as a routine part of migraine therapy in emergency settings [31]. Recently published studies have indicated that IV fluids offer no benefit in treating migraine headache pain [37,38]. The results of our study support this lack of benefit, as IV fluid boluses were associated with increased need for second round medications.…”

Section: Previous Literaturesupporting

confidence: 73%

Optimal management strategies for primary headache in the emergency department

et al. 2021

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Purpose We sought to evaluate the factors associated with better outcomes for emergency department (ED) patients treated for primary headache. Methods This was a health records review of consecutive patients over a 3-month period presenting to two tertiary EDs and discharged with a diagnosis of primary headache. The primary outcome was the need for second round medications, defined as medications received > 1 h after the initial physician-ordered medications were administered. We performed multivariate logistic regression analysis to determine treatment factors associated with need for second round medications. Results We included 553 patients, mean age was 42.2 years and 72.9% were females. The most common diagnoses were headache not otherwise specified (48.8%) and migraine (43%). Ketorolac IV (62.2%) and metoclopramide IV (70.2%) were the most frequently administered medications. 18% of patients met the primary outcome. Dopamine antagonists (OR 0.3 [95% CI 0.1-0.5]) and non-steroidal anti-inflammatory drugs (NSAIDs) (OR 0.5 [95% CI 0.3-0.8]) ordered with initial medications were associated with reduced need for second round medications. Intravenous fluid boluses ≥ 500 ml (OR 2.8 [95% CI: 1.5-5.2]) and non-dopamine antagonist antiemetics (OR 2.2 [95% CI 1.2-4.2]) were associated with increased need. Opioid use approached statistical significance for receiving second round medication (p = 0.06). ConclusionWe determined that use of dopamine antagonists and NSAIDs were associated with a reduced need for second round medications in ED primary headache patients. Conversely, non-dopamine antagonist antiemetic medications and intravenous fluids were associated with a significantly increased need for second round medications. Careful choice of initial therapy may optimize management for these patients. Keywords Headache • Migraine • Emergency department RésuméObjectif Nous avons cherché à évaluer les facteurs associés à de meilleurs résultats pour les patients des services d'urgence traités pour des céphalées primaires. Méthodes Il s'agissait d'un examen des dossiers médicaux de patients consécutifs sur une période de 3 mois se présentant à deux services d'urgence tertiaires et sortis avec un diagnostic de céphalée primaire. Le résultat primaire était la nécessité d'une deuxième série de médicaments, définis comme des médicaments reçus > 1 heure après l'administration des premiers

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Section: Previous Literaturesupporting

confidence: 73%

Optimal management strategies for primary headache in the emergency department

et al. 2021

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“…Richer et al reported that IV infusion of normal saline (10 ml/kg) over 30 min resulted in a pain reduction of 12.5 mm VAS; the reduction was deemed not meaningful 31 . Other studies demonstrated that the addition of IV fluid (up to 1 L of normal saline) to IV neuroleptic accomplished no more pain control than IV neuroleptics alone 32–34 . Although there is no consensus on the role of hydration in migraine treatment, IV fluid is commonly used in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…31 Other studies demonstrated that the addition of IV fluid (up to 1 L of normal saline) to IV neuroleptic accomplished no more pain control than IV neuroleptics alone. [32][33][34] Although there is no consensus on the role of hydration in migraine treatment, IV fluid is commonly used in clinical practice. In addition, previous studies of IV ketorolac on renal colic or postoperative pain have used a smaller volume (50 ml) or IV push.…”

Section: Discussionmentioning

confidence: 99%

Intravenous ibuprofen for acute treatment of migraine: A double‐blind, randomized, placebo‐controlled pilot study

et al. 2021

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Objective To evaluate the efficacy and safety of intravenous (IV) Ibuprofen for acute treatment of migraine. Background IV nonsteroidal anti‐inflammatory drugs (NSAIDs) are an alternative to oral NSAIDs, especially in patients with severe migraine who have emesis or gastroparesis. To date, only three IV NSAIDs (ketorolac, ibuprofen, and meloxicam) are available in the United States for use in moderate and severe pain, but no placebo‐controlled trial is available for migraine. We performed a single‐center, double‐blind, randomized, placebo‐controlled pilot study to evaluate the efficacy and safety of IV ibuprofen as an acute treatment of migraine (NCT01230411). Methods Individuals with episodic migraine were screened at the Jefferson Headache Center. Qualified subjects were treated for migraine attacks within 2–72 h following the headache onset with either 800 mg of IV ibuprofen or placebo in 250 ml saline bolus. Migraine pain intensity (4‐point Likert scale) and associated symptoms were assessed at predetermined time points (0.25, 0.5, 1, 1.5, 2, 4, 8, 24 h). The primary endpoint was pain relief at 2 h after infusion. Important secondary endpoints included pain freedom at 2 h, sustained relief over 24 h, use of rescue therapy, and absence of associated symptoms. Adverse events (AEs) were also collected. Results Seventy‐four participants were enrolled between 2011 and 2017. Forty‐four subjects (female 33/44; 75.0%) with mean (SD) age 41.0 (11.2) 11.2 years came for the treatment. All treated subjects (n = 44) were included in the analysis. Among them, 23 were randomized to receive IV ibuprofen. Both groups were demographically similar except for longer migraine duration (i.e., years lived with disease) in the active treatment than in the placebo group. At 2 h posttreatment, pain relief was found in 74% (17/23) and 48% (10/21) after IV ibuprofen and placebo, respectively (odds ratio [OR] 3.12, 95% CI: 0.88–11.0; p = 0.078). Other secondary endpoints at 2 and 24 h were not significant. The longitudinal repeated‐measures analysis within 2 h on ibuprofen treatment showed significant pain relief (OR 2.47, 95% CI 1.08–5.7; p = 0.033) and absence of associated symptoms: photophobia (OR 4.0, 95% CI 1.57–10.3; p = 0.004), phonophobia (OR 3.12, 95% CI 1.16–8.4; p = 0.025), and osmophobia (OR 3.45, 95% CI 1.01–11.8; p = 0.048). AEs were observed in seven subjects in both groups, with arm pain being the most common. No serious AE was reported. Conclusion This study did not meet the primary endpoint but showed pain relief and elimination of several associated symptoms within 2 h on repeated‐measures analysis. Although limited by small sample size and high placebo response, our results indicate that IV ibuprofen may be a safe and effective option for acute treatment of migraine, but more extensive studies are necessary.

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