Metoclopramide as an Analgesic in Severe Migraine Attacks: An Open, Single-blind, Parallel Control Study

Abstract

Metoclopramide is a well-known anti-emetic drug with central and peripheral pharmacological effects. Some authors have reported metoclopramide as an adjunct therapy to other analgesics in patients with migraine attacks. Treatment of migraine headache using a mix of metoclopramide and an NSAID has been patented (European Patent EP1014961) as well as a short series showing great efficacy and tolerability of metoclopramide in patients wtih migraine attacks. We decided to conduct an open, single-blind, parallel control study in the emergency department to evaluate the efficacy and tolerability of metoclopramide in patients with severe migraine attacks. 93 consecutive patients with severe migraine attacks were randomized into two groups (groups A and B). Patients in group A received 10mg of intravenous metoclopramide and patients in group B received 1 g of intravenous paracetamol. Patients were evaluated 5 minutes before (baseline), 15, 30, 60 and 120 minutes after drug delivery, and before being discharged from the emergency department They were then contacted by phone 48 hours after being discharged from the hospital (phone questionnaire). Patients treated with either metoclopramide or paracetamol showed a significant reduction in the intensity of pain at the 120 minute time point, with an 86% and 82% improvement respectively. However, patients treated with metoclopramide showed a more rapid improvement at the 15 and 30 minute evaluations. Patients with severe migraine attacks treated with metoclopramide as monotherapy showed a significant improvement in terms of pain relief and a faster improvement in pain intensity compared to those treated with paracetamol. Metoclopramide and other dopamine antagonistic drugs should be considered a therapeutic option in severe migraine headache attacks.

Evaluation of the antinociceptive effect of xylazine and it’s interaction with metoclopramide in the acute pain model in mice

“…Metoclopramide is well known as antiemetic, but recently reported as analgesic in man (6,7), dog (8), rat (9) and mice, alone or as a combination with other drugs as ketamine 3, tramadol (29) and diphenhydramine (30). (32). ED50 of xylazine and metoclopramide was 10.8 and 25.6 mg/kg, IP respectively.…”

Critical reappraisal of intravenous metoclopramide in migraine attack: a systematic review and meta-analysis

“…Two studies in Chinese, one of them comparing metoclopramide to flunarizine and the other one comparing metoclopramide to sumatriptan [15,16]; 1 study in Spanish comparing metoclopramide to dipyrone [17]; and an open-label, singleblind study comparing metoclopramide to IV paracetamol were not available as full text avoiding the interpretation of their results [18]. The studies comparing metoclopramide to placebo are so heterogeneous and prone to high risk of bias that prevent us from drawing a conclusion whether and how much metoclopramide is superior to placebo.…”

Propofol Alleviates Intractable Migraine Headache: A Case Report

“…Several medications including intravenous non-steroidal anti-inflammatory drugs, paracetamol, triptans, Phenothiazines, new atypical antipsychotics, metoclopramide and opioids have been proposed as the first line drugs in the treatment of migraine attack (1)(2)(3)(4)(5)(6). However, the low efficacy, potential complications of medications and the intolerance of some patients for oral route due to nausea and vomiting, establish a difficult situation in some migraine patients.…”