A randomized, double-blind, comparative study of the efficacy of ketorolac tromethamine versus meperidine in the treatment of severe migraine.
ABSTRACT To evaluate the relative efficacy of ketorolac tromethamine and meperidine hydrochloride in the emergency department treatment of severe migraine.
Prospective, randomized, double-blind trial.
University hospital ED.
Patients presenting to the ED with an isolated diagnosis of common or classic migraine.
Subjects were randomized to receive a single intramuscular injection of either 30 mg ketorolac or 75 mg meperidine.
Of the 31 patients completing the trial, 15 received ketorolac and 16 received meperidine. The demographic characteristics of both groups were comparable. At one hour, ketorolac was significantly less effective than meperidine in reducing headache pain (P = .02) and in improving clinical disability (P = .01). Ketorolac also was less effective at reducing nausea, photophobia, and the need for rescue medication (P less than .05). Sustained headache relief was experienced by 44% of the patients treated with meperidine at 12- to 24-hour follow-up, compared with 13% of the patients treated with ketorolac (P = NS). No significant side effects were observed for either group.
IM ketorolac tromethamine is less effective than meperidine in the ED treatment of severe migraine.
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ABSTRACT: Objective: To provide physicians and allied health care professionals with guide- lines for the diagnosis and management of migraine in clinical practice. Options: The full range and quality of diagnostic and therapeutic methods avail- able for the management of migraine. Outcomes: Improvement in the diagnosis and treatment of migraine, which will lead to a reduction in suffering, increased productivity and decreased economic burden. Evidence and values: The creation of the guidelines followed a needs assessment by members of the Canadian Headache Society and included a statement of ob- jectives; development of guidelines by multidisciplinary working groups using information from literature reviews and other resources; comparison of alterna- tive clinical pathways and description of how published data were analysed; definition of the level of evidence for data in each case; evaluation and revision of the guidelines at a consensus conference held in Ottawa on Oct. 27-29, 1995; redrafting and insertion of tables showing key variables and data from various studies and tables of data with recommendations; and reassessment by all con- ference participants. Benefits, harms and costs: Accuracy in diagnosis is a major factor in improving ther- apeutic effectiveness. Improvement in the precise diagnosis of migraine, coupled with a rational plan for the treatment of acute attacks and for prophylactic ther- apy, is likely to lead to substantial benefits in both human and economic terms. Recommendations: The diagnosis of migraine can be improved by using modified criteria of the International Headache Society as well as a semistructured patient interview technique. Appropriate treatment of symptoms should take into ac- count the severity of the migraine attack, since most patients will have attacks of differing severity and can learn to use medication appropriate for each attack. When headaches are frequent or particularly severe, prophylactic therapy should be considered. Both the avoidance of migraine trigger factors and the ap- plication of nonpharmacological therapies play important roles in overall mi- graine management and will be addressed at a later date. Validation: The guidelines are based on consensus of Canadian experts in neurol- ogy, emergency medicine, psychiatry, psychology, family medicine and phar- macology, and consumers. Previous guidelines did not exist. Field testing of the guidelines is in progress. Sponsors: Support for the consensus conference was provided by an unrestricted educational grant from Glaxo Wellcome Inc. Editorial coordination was pro- vided by Medical Education Programs Canada Inc.
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ABSTRACT: Migraine can be a disabling condition for the suVerer. For the small number of patients who fail home therapy and seek treatment in an emergency department, there are a number of therapeutic options. This paper reviews the evidence regarding the eVectiveness and safety of the following therapies: the phenothiazines, lignocaine (lidocaine), ketorolac, the ergot alkaloids, metoclopramide, the "triptans", haloperi- dol, pethidine and magnesium. Based on available evidence, the most eVective agents seem to be prochlorperazine,chlor- promazine and sumatriptan,each of which have achieved greater then 70% eYcacy in a number of studies. (J Accid Emerg Med 2000;17:241-245)