Parenteral metoclopramide for acute migraine: meta-analysis of randomised controlled trialsBMJ 2004; 329 doi: https://doi.org/10.1136/bmj.38281.595718.7C (Published 09 December 2004) Cite this as: BMJ 2004;329:1369
- Ian Colman, postgraduate1,
- Michael D Brown, emergency physician2,
- Grant D Innes, emergency physician3,
- Eric Grafstein, emergency physician3,
- Ted E Roberts, neurologist4,
- Brian H Rowe (), research director5⇑
- 1 Department of Psychiatry, University of Cambridge, Cambridge CB2 2QQ
- 2 Program in Emergency Medicine, Michigan State University, MI, 49503, USA
- 3 Department of Emergency Medicine, Providence Health Care and St Paul's Hospital, Vancouver, BC, Canada
- 4 Department of Medicine, University of Alberta, Edmonton, AB, Canada
- 5 Division of Emergency Medicine, University of Alberta, 1G1.43 Walter Mackenzie Health Sciences Center, 8440-112 Street, Edmonton, AB, Canada T6G 2B7
- Correspondence to: B H Rowe
- Accepted 6 October 2004
Objective To assess the evidence from controlled trials on the efficacy and tolerability of parenteral metoclopramide for acute migraine in adults.
Data sources Cochrane Central Register of Controlled Trials, Medline, Embase, LILACS, CINAHL, conference proceedings, clinical practice guidelines, and other sources.
Selection criteria 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.
Contributors IC conceived the project, conducted searches, coordinated the reviewers, data collection, and extraction, and prepared the manuscript. MDB contributed to the protocol, data collection and extraction, and review of the manuscript. GDI, EG, and TER contributed to the protocol, selection of articles, and review of the manuscript. BHR conceived the project, contributed to the protocol, coordinated the review, and prepared the manuscript; he is guarantor.
Funding This study was funded in part by the Division of Emergency Medicine, University of Alberta, Edmonton; the Canadian Institute of Health Research chairs programme, Ottawa; and the Canadian Association of Emergency Physicians Research Consortium, Ottawa.
Competing interests BHR has received fees on two occasions from Aventis for speaking on venous thromboembolism. He has not been sponsored to speak on Maxeran or migraine headaches.
Ethical approval Not required.