title: Transnasal butorphanol in the emergency department management of migraine headache.
abstract: Transnasal butorphanol (TNB) is a mixed agonist-antagonist opioid that has recently been released for the treatment of painful conditions. Patients with a history of migraine diagnosed in either of two emergency departments (EDs) with a moderate or severe migraine were eligible for this prospective study. Patients received 1 mg of TNB at time zero and again in 45 minutes if needed. Twenty-five patients were studied. Pain intensity was measured on a 10-cm visual analog scale. Mean pain intensity was significantly decreased at 15 minutes and declined from 7.9 +/- 1 cm initially to 2.5 +/- 3.3 cm at 90 minutes. Sixty percent of the patients required no further treatment. Thirty-six percent experienced side effects, with all but 1 being mild or moderate. Seventy-five percent rated the treatment as good, very good, or excellent, and 71% would prefer to receive TNB for future migraines over other treatment options. TNB offers rapid, effective pain relief to the majority of ED migraine patients.
authors.affiliation: Emergency Medicine Residency of the Lehigh Valley, St. Luke's Hospital, Bethlehem, PA 18015, USA.
authors.forename: S W
authors.initials: SW
authors.lastname: Melanson
authors.forename: J W
authors.initials: JW
authors.lastname: Morse
authors.forename: D J
authors.initials: DJ
authors.lastname: Pronchik
authors.forename: M B
authors.initials: MB
authors.lastname: Heller
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D002077:Butorphanol / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D002077:Butorphanol