Current emergency treatment of severe migraine headaches.
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.
Klapper
J A
JA
St. Joseph Hospital, Denver, CO 80218.
Stanton
J
J
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
D006919:Hydroxyzine; D004087:Dihydroergotamine; D008614:Meperidine; D008787:Metoclopramide