A randomized, double-blind, comparative study of the efficacy of ketorolac tromethamine versus meperidine in the treatment of severe migraine.
OBJECTIVE
To evaluate the relative efficacy of ketorolac tromethamine and meperidine hydrochloride in the emergency department treatment of severe migraine.


METHODS
Prospective, randomized, double-blind trial.


METHODS
University hospital ED.


METHODS
Patients presenting to the ED with an isolated diagnosis of common or classic migraine.


METHODS
Subjects were randomized to receive a single intramuscular injection of either 30 mg ketorolac or 75 mg meperidine.


RESULTS
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.


CONCLUSIONS
IM ketorolac tromethamine is less effective than meperidine in the ED treatment of severe migraine.
Larkin
G L
GL
Department of Surgery, West Virginia University Health Sciences Center, Morgantown.
Prescott
J E
JE
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D004311:Double-Blind Method; D004338:Drug Combinations; D004630:Emergencies; D005260:Female; D006801:Humans; D020911:Ketorolac Tromethamine; D008297:Male; D008614:Meperidine / Q000627:therapeutic use*; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy*; D011446:Prospective Studies; D012720:Severity of Illness Index; D014046:Tolmetin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome; D014325:Tromethamine / Q000627:therapeutic use*
D000700:Analgesics; D004338:Drug Combinations; D014325:Tromethamine; D020911:Ketorolac Tromethamine; D008614:Meperidine; D014046:Tolmetin