This review leaves me a bitter taste. That metoclopramide can be
statistically shown more effective than placebo is indeed good news.
But the number needed to treat is 4.
I understand 3 patients will not be relieved.I cannot be convinced
that I should use this treatment alone in my emergency department.
We need randomised controlled trials of triptans vs cheap, widely
used emergency department treatments: IV NSAIDs, neuroleptics, IV
paracetamol, dihydroergotamin and their combinations.
Our ED migraineurs probably are not similar to most patients enrolled
in RCTs led by neurologists. Neurologists treat migraine headaches that
have not yet occurred and that they do not see, whereas emergency
physicians actually see and treat ongoing migraines that probably are
different since the patient goes to the ED.
Rapid Response:
Number not to respond ?
This review leaves me a bitter taste. That metoclopramide can be statistically shown more effective than placebo is indeed good news.
But the number needed to treat is 4.
I understand 3 patients will not be relieved.I cannot be convinced that I should use this treatment alone in my emergency department.
We need randomised controlled trials of triptans vs cheap, widely used emergency department treatments: IV NSAIDs, neuroleptics, IV paracetamol, dihydroergotamin and their combinations.
Our ED migraineurs probably are not similar to most patients enrolled in RCTs led by neurologists. Neurologists treat migraine headaches that have not yet occurred and that they do not see, whereas emergency physicians actually see and treat ongoing migraines that probably are different since the patient goes to the ED.
Competing interests: None declared
Competing interests: No competing interests