Intravenous caffeine citrate vs. magnesium sulfate for reducing pain in patients with acute migraine headache; a prospective quasi-experimental study

Abstract

BackgroundCurrent evidence suggests that intravenous magnesium sulfate might be effective for reducing migraine pain. In a recent pilot study, we showed that intravenous caffeine citrate could reduce the severity of migraine headache. The objective of this study is to investigate the efficacy of intravenous caffeine citrate vs. magnesium sulfate for management of acute migraine headache.MethodsWe conducted a prospective quasi-experimental study from January until May 2016 in two educational medical centers of Shahid Beheshti University of Medical Sciences (Shoahadaye Tajrish Hospital and Imam Hossein Hospital), Tehran, Iran. The study included patients who were referred to the emergency department and met the migraine diagnosis criteria of the International Headache Society. Patients were allocated into 2 groups receiving either 60 mg intravenous caffeine or 2 g intravenous magnesium sulfate. The pain scores, based on the visual analog scale, were recorded on admission, as well as one and two hours after receiving the drug. A Chi-Square test and student t-test were used for analysis of baseline characteristics. A Mann-Whitney U test and Wilcoxon singed rank test were used to analyze differences in the visual analogue scale (VAS) score between and within the groups respectively.ResultsIn total, 70 patients (35 patients in each group) with the mean age of 33.1 ± 11.3 years were included (64.3% female). For the Caffeine citrate group, the median pain score decreased from 9.0 (2.0) to 5.0 (4.0) after one hour and to 3.0 (4.0) after two hours. For the magnesium sulfate group, the pain score decreased from 8.0 (2.0) to 2.0 (2.0) after one hour and to 0.0 (1.0) after two hours. Both intravenous caffeine citrate and intravenous magnesium sulfate reduced pain scores significantly but the magnesium sulfate group showed more improvement than the Caffeine citrate group after one hour (P < 0.001) and after two hours (P < 0.001).ConclusionsIt is likely that both intravenous caffeine and intravenous magnesium sulfate can reduce the severity of migraine headache. Moreover, intravenous magnesium sulfate at a dose of 2 g might be superior to intravenous caffeine citrate 60 mg for the short term management of migraine headache in emergency departments.

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

“…[13][14][15] A series of cases using magnesium sulfate plus ketamine for chronic cluster headache reported improvement with effects lasting up to 6 months. However, literature suggests patients may have near immediate improvement in pain scores, with notable VAS score reductions within 1-2 hours, and lasting for up to 24 hours post-dose.…”

“…However, literature suggests patients may have near immediate improvement in pain scores, with notable VAS score reductions within 1-2 hours, and lasting for up to 24 hours post-dose. 12,14,15,[18][19][20][21][22][23][25][26][27][28]30,31,35,36,[44][45][46] Most studies assess single-dose regimens; however, evidence exists suggesting benefit for daily dosing over 5-7 days. 12,44 Consensus regarding magnesium sulfate dosing for headaches is lacking, with reported dosing ranging from 500 to 3000-mg boluses administered over 10-30 minutes.…”

“…12,14,15,[18][19][20][21][22][23][25][26][27][28]30,31,35,36,[44][45][46] Most studies assess single-dose regimens; however, evidence exists suggesting benefit for daily dosing over 5-7 days. 14,48 No interactions have been observed between other headache pharmacologic agents, including NSAIDs, triptans, DHE, valproic acid, and caffeine. 47 Efficacy is not contingent on baseline serum magnesium levels; 27 however, patients with lower baseline magnesium levels may have greater improvement and complete resolution of symptoms compared to patients with higher baseline magnesium levels.…”

“…Among those excluded were 6 non-randomized trials [14][15][16]18,19,32 and 5 abstracts for which the authors did not respond to correspondence. Among those excluded were 6 non-randomized trials [14][15][16]18,19,32 and 5 abstracts for which the authors did not respond to correspondence.…”

Effect of Dexmedetomidine Infusion During Orthopedic Surgery on Postoperative Analgesic Consumption in Opium Addict Patients; A Randomized Clinical Trial

“…Inappropriate pain management in different settings, from the emergency department to the operating room and afterward, has been documented in the current literature and research regarding better approach is still ongoing (5)(6)(7)(8). The efficient management of POP is currently a part of surgery process and reduces patients' morbidity as well as their mortality, accelerates recovery and discharge from the hospital, improves patients' quality of life, and reduces costs.…”