Colman Ian, Brown Michael D, Innes Grant D, Grafstein Eric, Roberts Ted E, Rowe Brian H
Department of Psychiatry, University of Cambridge, Cambridge CB2 2QQ.
BMJ. 2004 Dec 11;329(7479):1369-73. doi: 10.1136/bmj.38281.595718.7C. Epub 2004 Nov 18.
To assess the evidence from controlled trials on the efficacy and tolerability of parenteral metoclopramide for acute migraine in adults.
Cochrane Central Register of Controlled Trials, Medline, Embase, LILACS, CINAHL, conference proceedings, clinical practice guidelines, and other sources.
Randomised controlled trials of parenteral metoclopramide for acute migraine in adults.
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.
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.
评估关于成人急性偏头痛使用胃肠外甲氧氯普胺的疗效和耐受性的对照试验证据。
Cochrane对照试验中心注册库、医学期刊数据库、荷兰医学文摘数据库、拉丁美洲和加勒比地区卫生科学数据库、护理学与健康领域数据库、会议论文集、临床实践指南及其他来源。
成人急性偏头痛使用胃肠外甲氧氯普胺的随机对照试验。
我们查阅了596篇可能相关的摘要，发现13项符合条件的试验，共纳入655名成人。在比较甲氧氯普胺与安慰剂的研究中，甲氧氯普胺更有可能显著减轻偏头痛疼痛（比值比2.84，95%置信区间1.05至7.68）。作为唯一药物使用时，与其他单一药物相比，甲氧氯普胺的疗效不一。联合治疗研究的异质性妨碍了统计合并。在所有研究报告的疼痛、恶心和复发结局方面，包含甲氧氯普胺的治疗与对照治疗效果相当或更佳。
甲氧氯普胺是偏头痛的有效治疗药物，与其他治疗联合使用时可能也有效。鉴于其非麻醉性和止吐特性，甲氧氯普胺应被视为急诊科治疗急性偏头痛的一线药物。
