Subcutaneous Sumatriptan for Treatment of Acute Migraine in Patients Admitted to the Emergency Department: A Multicenter Study

Akpunonu, Basil E.; Mutgi, Anand B.; Federman, Douglas J.; Volinsky, Fred G; Brickman, K.; Davis, Randy; Gilbert, Carol; Asgharnejad, Mahnaz

doi:10.1016/s0196-0644(95)70259-8

Cited by 94 publications

(76 citation statements)

References 23 publications

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“…However, previous work has demonstrated that migraineurs who were pain-free 24 hours after ED discharge did not experience a recurrent headache over the next 48 hours. 28 7) There was no assessment of blinding and allocation concealment. It therefore remains unknown whether subjects knew which medication they received and how this may have influenced the results.…”

Section: Discussionmentioning

confidence: 99%

A trial of metoclopramide vs sumatriptan for the emergency department treatment of migraines

et al. 2005

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Section: Discussionmentioning

confidence: 99%

A trial of metoclopramide vs sumatriptan for the emergency department treatment of migraines

et al. 2005

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“…Thirteen trials were not included in the analysis: six allowed rescue medication within 2 h [12][13][14][15][16][17]. one was published twice [18], one was an interim analysis of a trial that was later published in full [19], one was a subgroup analysis of patients in two trials which had been published previously [20], one contained inconsistencies about the number of patients with adequate pain relief [21], one assessed pain relief but not at 2 h [22], and two did not provide data on the first administration in a cross-over design [23,24].…”

Section: Search For Studies and Inclusion Criteriamentioning

confidence: 99%

Placebo effect in the acute treatment of migraine: subcutaneous placebos are better than oral placebos

Craen¹,

Tijssen²,

Gans

et al. 2000

Journal of Neurology

242

157

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We carried out a meta-analysis of 22 trials to determine the comparative placebo effect of (a) subcutaneous vs. oral and (b) in-hospital vs. at-home administration in the treatment of migraine. The headache relief rates were combined from the placebo arms of these randomised clinical trials assessing the value of sumatriptan in acute treatment of migraine. The main outcome measure was the proportion of patients reclassified from severe or moderate headache severity to no or mild headache severity 2 h after the beginning of treatment. In the oral regimen 222 of 865 patients (25.7%) reported no or mild headache severity after 2 h, compared to 279 of 862 patients (32.4%) of those receiving subcutaneous placebo (6.7% difference; 95% CI 2.4-11.0%). Adjusting for treatment setting and severity of headache at baseline did not change the observed difference. After placebo treatment at home 285 of 1,054 patients (27.0%) reported no or mild headache severity after 2 h, compared to 216 of 673 patients (32.1%) among those receiving placebo in hospital (5.1 % difference; 95% CI 0.6-9.5%). When adjusted for route of administration and severity of headache at baseline, the difference in relief rates between home and hospital setting disappeared. These findings indicate that subcutaneous administration enhances the placebo effect of acute treatment of migraine. Future trials of antimigraine drugs assessing the relative efficacy of various routes of administration should use a double-dummy technique. The interpreting of placebo-controlled trial results must therefore consider that the effect in the drug arm of the trial depends in part on the route of administration.

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“…'0'2 The reported success rate of sumatriptan regimens varies from 49% to 80%. [13][14][15] There is a considerable cost difference between these agents, with an ampoule of chlorpromazine costing Australian hospital pharmacies A$0.71, compared with A$47.31 for an ampoule of sumatriptan.…”

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Intravenous chlorpromazine versus intramuscular sumatriptan for acute migraine.

Kelly

Ardagh

Curry

et al. 1997

Emergency Medicine Journal

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Objective-To establish whether there is any difference in the efficacy of a chlorpromazine regimen and a sumatriptan regimen for the management of the pain of acute severe migraine. Setting-Two urban teaching hospital emergency departments. Methods-Prospective, randomised, unblinded, crossover trial. All patients received intravenous metoclopramide 10 mg and 1000 ml of normal saline over 1 h; 20 were then randomised to receive intramuscular sumatriptan 6 mg and 23 to receive intravenous chlorpromazine, 12.5 mg increments to a maximum of 37.5 mg. Response to treatment was measured using visual analogue pain scales. Results-No difference in efficacy between the sumatriptan regimen and the chlorpromazine regimen was found. Adverse effects were mild and equally distributed between the groups. Conclusions-The chlorpromazine and sumatriptan regimens studied are both very effective for the relief ofthe headache of severe migraine. (JAccid Emerg Med 1997;14:209- Chlorpromazine is a phenothiazine used mainly for the treatment of psychiatric disorders. It is a powerful antagonist of the neurotransmitter action of dopamine in the basal ganglia and limbic system. It is also a potent antiemetic through its action on the chemoreceptor trigger zone. Its neuroleptic actions appear to alter pain perception. It is also an a adrenergic antagonist with some anticholinergic properties. The a blocking action of chlorpromazine can result in orthostatic hypotension. Chlorpromazine acts as an antagonist at both histamine and 5-hydroxytryptamine (5-HT) receptors.4 During short term use, the side effects of chlorpromazine are dose dependent orthostatic hypotension, lowering of the seizure threshold, tremors, and drowsiness. Dystonia is an idiosyncratic reaction and may occur after a single dose.4 The mechanism of action of chlorpromazine in migraine is uncertain. It is possibly the result of a combination of actions, including the anti-5-HT effect, an antidopamine effect in the chemoreceptor trigger zone, and vascular effects through its a blocking action.5 The reported success rate of chlorpromazine regimens in the treatment of migraine varies from 47% to 96%.5 Sumatriptan is a specific and selective 5-HT (subtype ID) agonist that has no effect on other 5-HT receptor subtypes. This receptor is found predominantly in cranial blood vessels and when stimulated produces constriction of large blood vessels which may be dilated during attacks of migraine.'°Clinical response begins within 10-15 minutes of subcutaneous injection." Adverse effects include drowsiness, weakness, dizziness, flushing, rash, pruritus, increase in blood pressure, chest pain, and chest tightness. Sumatriptan is contraindicated in patients with a history of ischaemic heart disease and uncontrolled hypertension and in those using ergot preparations." The antimigraine effect of sumatriptan is thought to be due to its effect on the 5-HT subtype 1D receptors in cranial blood vessels.'0'2 The reported success rate of sumatriptan regimens varies from 49% to 80%. [13]...

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Subcutaneous Sumatriptan for Treatment of Acute Migraine in Patients Admitted to the Emergency Department: A Multicenter Study

Cited by 94 publications

References 23 publications

A trial of metoclopramide vs sumatriptan for the emergency department treatment of migraines

A trial of metoclopramide vs sumatriptan for the emergency department treatment of migraines

Placebo effect in the acute treatment of migraine: subcutaneous placebos are better than oral placebos

Intravenous chlorpromazine versus intramuscular sumatriptan for acute migraine.

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