Parenteral metoclopramide for acute migraine: meta-analysis of randomised controlled trials.
OBJECTIVE
To assess the evidence from controlled trials on the efficacy and tolerability of parenteral metoclopramide for acute migraine in adults.


METHODS
Cochrane Central Register of Controlled Trials, Medline, Embase, LILACS, CINAHL, conference proceedings, clinical practice guidelines, and other sources.


METHODS
Randomised controlled trials of parenteral metoclopramide for acute migraine in adults.


RESULTS
We reviewed 596 potentially relevant abstracts and found 13 eligible trials totalling 655 adults. In studies comparing metoclopramide with placebo, metoclopramide was more likely to provide significant reduction in migraine pain (odds ratio 2.84, 95% confidence interval 1.05 to 7.68). Used as the only agent, metoclopramide showed mixed effectiveness when compared with other single agents. Heterogeneity of studies for combination treatment prevented statistical pooling. Treatments that did include metoclopramide were as, or more, effective than comparison treatments for pain, nausea, and relapse outcomes reported in all studies.


CONCLUSIONS
Metoclopramide is an effective treatment for migraine headache and may be effective when combined with other treatments. Given its non-narcotic and antiemetic properties, metoclopramide should be considered a primary agent in the treatment of acute migraines in emergency departments.
Colman
Ian
I
Department of Psychiatry, University of Cambridge, Cambridge CB2 2QQ.
Brown
Michael D
MD
Innes
Grant D
GD
Grafstein
Eric
E
Roberts
Ted E
TE
Rowe
Brian H
BH
D000328:Adult; D000932:Antiemetics / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007263:Infusions, Parenteral; D008787:Metoclopramide / Q000008:administration & dosage* / Q000009:adverse effects; D008881:Migraine Disorders / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D016896:Treatment Outcome
D000932:Antiemetics; D008787:Metoclopramide