ORIGINAL ARTICLE

Prospective, randomised, double blind, controlled comparison of metoclopramide and pethidine in the emergency treatment of acute primary vascular and tension type headache episodes

M Cicek¹, O Karcioglu¹, Parlak¹, V Ozturk², O Duman¹, M Serinken¹ and M Guryay¹

¹ Department of Emergency Medicine, Dokuz Eylul University Medical School, zmir, Turkey
² Department of Neurology, Dokuz Eylul University Medical School

Correspondence to:
Correspondence to:
Dr O Karcioglu
Department of Emergency Medicine, Dokuz Eylul University, Medical School, 35340, nciralt, zmir, Turkey; ozgur.karcioglu{at}deu.edu.tr

Study objective: To compare analgesic effects of metoclopramide (MTP), pethidine (PET), and combination of metoclopramide-pethidine (M-PET) in the treatment of adult patients with acute primary vascular and tension type headache admitted in the emergency department (ED).

Methods: All consecutive adult patients admitted into a university hospital ED in six months with acute vascular and tension type headache were recruited. The patients whose complaints had lasted no longer than seven days were randomised to four groups and thereby received 10 mg MTP intravenously plus placebo intramuscularly (MTP), 10 mg MTP intravenously plus 50 mg PET intramuscularly (M-PET), 50 mg PET intramuscularly plus placebo intravenously (PET); and intramuscular and intravenous placebo (PLC) in a blinded fashion. The patients were asked to report the degree of pain at 0, 15, 30, and 45 minutes on visual analogue scale (VAS) and demographic data and any side effects encountered were recorded. Rescue medication was used if required by the patient because of poor pain relief.

Results: Data regarding 336 patients meeting inclusion criteria were analysed. Mean VAS values recorded at 45 minutes were significantly higher in PLC group than in others (p = 0.000). When the PLC group was excluded, VAS scores in MTP and M-PET groups were significantly lower than in PET group (p = 0.038). Though unimportant, the incidence of side effects recorded in PET group was found to be significantly higher than in the other groups (p = 0.003).

Conclusion: These data suggest that MTP produces more effective analgesia than PET in both vascular and tension type headache in patients with acute primary headache episodes.

Keywords: headache; metoclopramide; pethidine

Abbreviations: ED, emergency department; MTP, metoclopramide; PET, pethidine; M-PET, metoclopramide-pethidine; VAS, visual analogue score

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Parlak, I., Erdur, B., Parlak, M., Ergin, A., Turkcuer, I., Tomruk, O., Ayrik, C., Ergin, N. (2007). Intravenous administration of metoclopramide by 2 min bolus vs 15 min infusion: does it affect the improvement of headache while reducing the side effects?. Postgrad. Med. J. 83: 664-668 [Abstract] [Full Text]  
• Parlak, I, Atilla, R, Cicek, M, Parlak, M, Erdur, B, Guryay, M, Sever, M, Karaduman, S (2005). Rate of metoclopramide infusion affects the severity and incidence of akathisia. Emerg. Med. J. 22: 621-624 [Abstract] [Full Text]  
• Marcovitch, H. (2004). What's new this month in BMJ Journals. BMJ 328: 1098-1098 [Full Text]