title: Current emergency treatment of severe migraine headaches.
abstract: OBJECTIVE
  To compare the efficacy of the combination of meperidine and hydroxyzine IM, versus dihydroergotamine and metoclopramide IV in the treatment of severe migraine headaches.
  
  
  METHODS
  This was a randomized double-blind, double-dummy study.
  
  
  METHODS
  Established patients, whose headache had failed to respond to their usual abortive agent, were invited to an out-patient headache clinic for the study.
  
  
  METHODS
  Twenty-eight patients, diagnosed as suffering from either migraine headache or chronic daily headache, were screened on arrival to exclude life-threatening causes.
  
  
  METHODS
  Group A (14 patients) received dihydroergotamine 1mg and metoclopramide 10mg IV and a placebo injection IM, and Group B (14 patients) received meperidine 75mg and hydroxyzine 75mg IM and a placebo injection IV.
  
  
  METHODS
  Patients rated their headaches on a scale of 0-3 prior to treatment and again at 30 and 60 minutes.
  
  
  RESULTS
  Both groups experienced improvement in headache severity. (Group A P = 0.001 and Group B P = 0.003). Improvement in pain scale score was greater for Group A than Group B. (P = 0.006). The number of patients having a mild or no headache in Group A (13/14) was significantly greater than Group B (3/14). (P < 0.001)
  
  
  CONCLUSIONS
  The combination of dihydroergotamine and metoclopramide IV should replace the standard IM narcotic and anti-emetic as the parenteral treatment of choice for severe migraine headache.
authors.affiliation: St. Joseph Hospital, Denver, CO 80218.
authors.forename: J A
authors.initials: JA
authors.lastname: Klapper
authors.forename: J
authors.initials: J
authors.lastname: Stanton
mesh_terms: D004087:Dihydroergotamine / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004630:Emergencies; D006801:Humans; D006919:Hydroxyzine / Q000008:administration & dosage / Q000627:therapeutic use; D007273:Injections, Intramuscular; D007275:Injections, Intravenous; D008614:Meperidine / Q000008:administration & dosage / Q000627:therapeutic use; D008787:Metoclopramide / Q000008:administration & dosage / Q000627:therapeutic use; D008881:Migraine Disorders / Q000188:drug therapy*; D010147:Pain Measurement
chemical_list: D006919:Hydroxyzine; D004087:Dihydroergotamine; D008614:Meperidine; D008787:Metoclopramide