Migraine and Other Causes of Headache☆☆☆★

Erdur

Postgraduate Medical Journal

et al. 2007

Objective: To determine the therapeutic effect (alleviation of vascular type headache) and side effects of a slow intravenous metoclopramide infusion over 15 min compared with those effects of a bolus intravenous metoclopramide infusion over 2 min in the treatment of patients with recent onset vascular type headache. Material and methods: All adults treated with metoclopramide for vascular type headache were eligible for entry into this clinical randomised double blinded trial. This study compared the effects of two different rates of intravenous infusion of metoclopramide over a period of 13 months at a university hospital emergency department. During the trial, side effects and headache scores were recorded at baseline (0 min), and then at 5, 15, 30 and 60 min. Repeated measures analysis of variance was used to compare the medication's efficacy and side effects. Results: A total of 120 patients presenting to the emergency department met the inclusion criteria. Of these, 62 patients (51.7%) were given 10 mg metoclopramide as a slow intravenous infusion over 15 min (SIG group) and 58 patients (48.3%) were given 10 mg metoclopramide intravenous bolus infusion over 2 min (BIG group). 17 of the 58 patients in the BIG group (29.3%) and 4 of the 62 patients (6.5%) in the SIG group had akathisia (p = 0.001). There were no significant differences between the BIG and SIG groups in terms of mean headache scores (p = 0.34) and no adverse reactions in the study period. Metoclopramide successfully relieved the headache symptom(s) of patients in both the BIG and SIG groups. Conclusion: Slowing the infusion rate of metoclopramide is an effective strategy for the improvement of headache and reducing the incidence of akathisia in patients with vascular type headache.

“…Headache, mostly benign, is the chief complaint of 1.7–2.5% of patients admitted to an emergency department 1. Its treatment is sometimes challenging for emergency physicians.…”

mentioning

confidence: 99%

Intravenous administration of metoclopramide by 2 min bolus vs 15 min infusion: does it affect the improvement of headache while reducing the side effects?

Erdur

Postgraduate Medical Journal

et al. 2007

“…Treatment of migraine is pharmacologic and nonpharmacologic, with the overall goal to prevent and abort attacks. 35 Therapy is determined by thoroughly evaluating all characteristics of the attack, such as history, possible triggers, duration, quality, intensity, frequency, location, other symptoms, and previous responses to therapy. A physical or neurologic examination may be warranted.…”

Section: Treatment Of Migrainementioning

confidence: 99%

Migraine: A Comprehensive Review of New Treatment Options

et al. 1999

Headaches are among the most common complaints reported to health care professionals and are classified by the International Headache Society as migraine, tension-type, or cluster, with additional subtypes. Classification and etiology of headache should be determined after thorough review of the patient's history. Once diagnosed, migraine can be treated by preventive or abortive measures. Recent developments add new options, including availability of drugs for intranasal administration (sumatriptan, dihydroergotamine) and 5-HT1B/1D agonists (rizatriptan, zolmitriptan, naratriptan, eletriptan). Although placebo-controlled trials are available, few comparative clinical trials of these agents have been conducted; however, important pharmacologic, pharmacokinetic, and clinical differences exist among the drugs.

“…Upper cervical pain and/or cervicogenic headaches are disorders that are frequently encountered in the general public. Approximately 70% to 90% of adults report a minimum of one headache annually, with only 5% seeking medical attention, 1 and a portion of these headaches originate from the cervical spine (approximately 17.8%) 2 . Sjaastad et al.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Management of Cervicogenic Headache

Sizer

Phelps²,

Azevedo

et al. 2005

Pain Practice

Upper cervical pain and/or headaches originating from the C0 to C3 segments are pain-states that are commonly encountered in the clinic. The upper cervical spine anatomically and biomechanically differs from the lower cervical spine. Patients with upper cervical disorders fall into two clinical groups: (1) local cervical syndrome; and (2) cervicocephalic syndrome. Symptoms associated with various forms of both disorders often overlap, making diagnosis a great challenge. The recognition and categorization of specific provocation and limitation patterns lend to effective and accurate diagnosis of local cervical and cervicocephalic conditions.