Metoclopramide plus Diphenhydramine Superior to Ketorolac for Nonmigraine Headaches
A randomized trial found better pain relief with the antiemetic combination than with the NSAID.
Medications recommended for headache treatment include nonsteroidal anti-inflammatory drugs (NSAIDs), prochlorperazine, metoclopramide, and caffeine. These authors compared two regimens in adult patients with recurrent headaches that did not meet definitions for migraine or cluster headache. In a randomized, double-blind study, 120 patients who presented to an academic emergency department received either intravenous metoclopramide (20 mg) plus diphenhydramine (25 mg), or intravenous ketorolac (30 mg).
After 1 hour, pain improvement was greater with the combination regimen (median improvement on an 11-point scale, 5 vs. 3 points). The combination regimen was also superior in sustained relief, requirement for rescue medications, and patient desire to receive the same treatment again.
COMMENT
This study joins a long list of prior studies that suggest that metoclopramide and prochlorperazine are excellent agents for headache treatment. But it would be unfortunate if we concluded from this study that there is any reason to treat benign headaches with intravenous medications. There is also no reason to use only one of these regimens. Common sense suggests that we simply treat these benign conditions with oral ibuprofen, oral prochlorperazine or metoclopramide, and perhaps also oral caffeine. Opioids and barbiturate/analgesic combinations (e.g., Fiorinal) should not be used.
CITATION(S):
- Friedman BW et al. A randomized trial of intravenous ketorolac versus intravenous metoclopramide plus diphenhydramine for tension-type and all nonmigraine, noncluster recurrent headaches. Ann Emerg Med 2013 Apr 5; [e-pub ahead of print]. (http://dx.doi.org/10.1016/j.annemergmed.2013.03.017)
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