Comparison of Intravenous Metoclopramide and Acetaminophen in Primary Headaches: a Randomized Controlled Trial.
BACKGROUND
Headache is the most common neurologic symptom among referees to the emergency department (ED), while the best treatment has not yet been found. Therefore, in the present study pain relief effects of metoclopramide and acetaminophen were compared in patients suffered acute primary headache.


METHODS
This study was a double-blind randomized clinical trial performed in Imam Khomeini Hospital, Urmia, Iran, through July to October 2014. All adult patients, with acute primary (migraine, tension type and cluster) headache referred to the ED were included in this study. Pain severity was measured with 10 centimeters numeric rating scales. The patients were randomized into two groups of intravenous (IV) metoclopramide (10 milligrams) and acetaminophen (1 gram). Pain score, success rate, and drug complications were compared between the 2 groups at 0, 15, 30, 60, and 120 minutes after injection.


RESULTS
100 patients were equally categorized into two groups (mean age of 32 ± 13.2 years; 51.2% male). Initial pain score in metoclopramide and acetaminophen groups were 9.1 and 9.4, respectively (p = 0.46). IV metoclopramide did not have any analgesic effect at 15 minutes, but had good effect at 30 minutes. While, the analgesic effect of acetaminophen initiated after 15 minutes. After 2 hours, both drugs had good therapeutic effect on primary headaches (p < 0.001).


CONCLUSIONS
The present study demonstrated that efficacy of metoclopramide for pain relief in primary headaches is lower than acetaminophen. In this regard, success rate of acetaminophen was 42.0% versus 0% for metoclopramide within 15 minutes. The efficacy of acetaminophen continued until 60 minutes.
Department of Emergency Medicine, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, IR Iran.
Gholamreza
G
Faridaalaee
Department of Emergency Medicine, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, IR Iran.
Seyed Hesam
SH
Rahmani
Department of Emergency Medicine, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, IR Iran.
Hamidreza
H
Mehryar
Department of Emergency Medicine, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, IR Iran.
Shahab
S
Bina Shishavan
Department of Internal Surgery, School of Nursing and Midwifery, International branch of Urmia University of Medical Sciences, Urmia, IR Iran.
Seyedeh Zahra
SZ
Merghati
Department of Anesthesiology, Urmia University of Medical Sciences, Urmia, IR Iran.
Mohammad Amin
MA
Valizade Hasanloei
Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, IR Iran.
Bahman
B
Naghipour
Department of Emergency Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Farzad
F
Rahmani
Metoclopramide; acetaminophen; acute pain; headache; migraine