Randomized trial of IV valproate vs metoclopramide vs ketorolac for acute migraine

Factor, Stewart A.; Friedman, Benjamin W.; Jankovic, Joseph; Garber, Leonid; Gallagher, E. John

doi:10.1212/01.wnl.0000455698.16732.0a

Cited by 11 publications

(5 citation statements)

References 10 publications

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“…It has been suggested that the midbrain dopaminergic system could play a role in cluster headache pathophysiology (40). Dopamine antagonists such as metoclopramide, which is usually given against nausea in migraine, has been proven to be also effective in the treatment of migraine headache itself (41–46). A specific cell group within the posterior hypothalamus has been shown to inhibit trigeminonociceptive firing of the trigeminocervical complex (47).…”

Section: Structure and Function: The Hypothalamusmentioning

confidence: 99%

Hypothalamic regulation of headache and migraine

2019

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Background The clinical picture, but also neuroimaging findings, suggested the brainstem and midbrain structures as possible driving or generating structures in migraine. Findings This has been intensely discussed in the last decades and the advent of modern imaging studies refined the involvement of rostral parts of the pons in acute migraine attacks, but more importantly suggested a predominant role of the hypothalamus and alterations in hypothalamic functional connectivity shortly before the beginning of migraine headaches. This was shown in the NO-triggered and also in the preictal stage of native human migraine attacks. Another headache type that is clinically even more suggestive of hypothalamic involvement is cluster headache, and indeed a structure in close proximity to the hypothalamus has been identified to play a crucial role in attack generation. Conclusion It is very likely that spontaneous oscillations of complex networks involving the hypothalamus, brainstem, and dopaminergic networks lead to changes in susceptibility thresholds that ultimately start but also terminate headache attacks. We will review clinical and neuroscience evidence that puts the hypothalamus in the center of scientific attention when attack generation is discussed.

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Section: Structure and Function: The Hypothalamusmentioning

confidence: 99%

Hypothalamic regulation of headache and migraine

2019

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“…Acute treatment targets the serotoninergic system (such as triptans), the inflammatory reaction (nonsteroidal anti-inflammatory drugs), and calcitonin gene related protein (CGRP) receptors [ 11 ]. Some preventive drugs belong to the family of antiepileptic drugs (such as Topiramate and Valproate) [ 12 , 13 ] or beta-1 blockers drugs (such as Propranolol and Metoprolol) [ 14 ]. A hyperexcitable brain state based on cortical spreading depression (CSD) has been postulated as a pathophysiological mechanism in migraine [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Preemptive Analgesic and Antioxidative Effect of Curcumin for Experimental Migraine

Bulboacă

Bolboacă

Stănescu

et al. 2017

BioMed Research International

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Objective Our study aimed to investigate the analgesic and antioxidative stress effects of Curcumin (CC) in experimental migraine induced by Nitroglycerin (NTG) on rats, compared with Indomethacin (ID) and Propranolol (PP) treatments. Material and Methods Five groups of 10 rats treated i.p. were investigated: control group (healthy rats) injected with saline solution (0.9%), NTG-control group injected with NTG (1 mg/100 gbw, bw = body weight), and three groups with pretreatment applied 30 min previous to the formalin test (NTG + CC group: Curcumin (10 mg/100 gbw), NTG + PP group: Propranolol (100 μg/100 gbw), and NTG + ID group: Indomethacin (0.5 mg/100 gbw)). Formalin test was performed and number of flinches and shakes were counted. Several oxidative stress parameters were also assessed. Results The smallest values of malondialdehyde (MDA), nitric oxide (NOx), and total oxidative status (TOS) were observed on NTG + CC with significant differences as compared with the control group (p < 0.0001). The group pretreated with Curcumin proved significantly smaller number of flinches and shakes compared with both NTG + PP and NTG + ID. Conclusion Our study demonstrates a superior activity of Curcumin not only versus control, but also versus Propranolol and Indomethacin.

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“…Therefore, valproate is a drug that is inferior to metoclopramide and ketorolac in improving acute migraine attacks. 117…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, valproate is a drug that is inferior to metoclopramide and ketorolac in improving acute migraine attacks. 117 The sole use of intravenous dexamethasone as a symptomatic therapy is not recommended in CM patients with moderate to severe attacks associated with severe vomiting or nausea; however, we recommend combining it with metoclopramide to avoid recurrence. We recommend doses of 4-16 mg (weak recommendation, low quality of evidence, 2C).…”

Section: Most Effective Treatments (Traditional and New) In CM For Acute Headaches Associated With Nausea Vomiting And Disabilitymentioning

confidence: 98%

Comprehensive management of adults with chronic migraine: Clinical practice guidelines in Mexico

Vélez-Jiménez

Chiquete-Anaya

Orta

et al. 2021

Cephalalgia Reports

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Introduction: Migraine is a polygenic multifactorial disorder with a neuronal initiation of a cascade of neurochemical processes leading to incapacitating headaches. Headaches are generally unilateral, throbbing, 4–72 h in duration, and associated with nausea, vomiting, photophobia, and sonophobia. Chronic migraine (CM) is the presence of a headache at least 15 days per month for ≥3 months and has a high global impact on health and economy, and therapeutic guidelines are lacking. Methods: Using the Grading of Recommendations, Assessment, Development, and Evaluations system, we conducted a search in MEDLINE and Cochrane to investigate the current evidence and generate recommendations of clinical practice on the identification of risk factors and treatment of CM in adults. Results: We recommend avoiding overmedication of non-steroidal anti-inflammatory drugs (NSAIDs); ergotamine; caffeine; opioids; barbiturates; and initiating individualized prophylactic treatment with topiramate eptinezumab, galcanezumab, erenumab, fremanezumab, or botulinum toxin. We highlight the necessity of managing comorbidities initially. In the acute management, we recommend NSAIDs, triptans, lasmiditan, and gepants alone or with metoclopramide if nausea or vomiting. Non-pharmacological measures include neurostimulation. Conclusions: We have identified the risk factors and treatments available for the management of CM based on a grading system, which facilitates selection for individualized management.

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Randomized trial of IV valproate vs metoclopramide vs ketorolac for acute migraine

Cited by 11 publications

References 10 publications

Hypothalamic regulation of headache and migraine

Hypothalamic regulation of headache and migraine

Preemptive Analgesic and Antioxidative Effect of Curcumin for Experimental Migraine

Comprehensive management of adults with chronic migraine: Clinical practice guidelines in Mexico

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