Study objective: To evaluate the relative efficacy of ketorolac tromethamine and meperidine hydrochloride in the emergency department treatment of severe migraine.
Design: Prospective, randomized, double-blind trial.
Setting: University hospital ED.
Participants: Patients presenting to the ED with an isolated diagnosis of common or classic migraine.
Interventions: Subjects were randomized to receive a single intramuscular injection of either 30 mg ketorolac or 75 mg meperidine.
Measurements and main results: Of the 31 patients completing the trial, 15 received ketorolac and 16 received meperidine. The demographic characteristics of both groups were comparable. At one hour, ketorolac was significantly less effective than meperidine in reducing headache pain (P = .02) and in improving clinical disability (P = .01). Ketorolac also was less effective at reducing nausea, photophobia, and the need for rescue medication (P less than .05). Sustained headache relief was experienced by 44% of the patients treated with meperidine at 12- to 24-hour follow-up, compared with 13% of the patients treated with ketorolac (P = NS). No significant side effects were observed for either group.
Conclusion: IM ketorolac tromethamine is less effective than meperidine in the ED treatment of severe migraine.