Najjar Mejdi, Hall Tyler, Estupinan Blanca
College of Medicine, University of Central Florida College of Medicine.
Cureus. 2017 Apr 20;9(4):e1181. doi: 10.7759/cureus.1181.
In light of recent warnings by the United States (US) Surgeon General and Centers for Disease Control (CDC) guidelines for recommending more prudent use of opioid narcotics, the search for a non-opioid alternative for aborting acute migraines is particularly relevant. The CDC also estimates the prevalence of opioid dependence may be as high as 26% among patients prescribed opioids for chronic pain, not due to cancer, in the primary care setting. Given such staggering data, it is imperative that we, as caretakers, not foster opioid dependence but rather continue to investigate non-opioid therapies for the management of acute migraines in the emergent care settings. Our literature review demonstrates that metoclopramide should be used more frequently as first-line therapy for an acute migraine over opioids. The use of opioids specifically has been discouraged as migraine treatment by the American Headache Society citing "insufficient evidence" as the main reason. Metoclopramide, specifically using the 10 mg dose, has been cited as "highly likely to be effective" by the same guidelines. Another major issue with opioids is the growing potential for abuse, thus minimizing the use of these drugs for only special circumstances would be beneficial overall.
鉴于美国卫生局局长最近发出的警告以及疾病控制中心关于建议更谨慎使用阿片类麻醉药的指南，寻找一种用于中止急性偏头痛的非阿片类替代药物尤为重要。疾病控制中心还估计，在初级保健机构中，因慢性疼痛（而非癌症）而开具阿片类药物处方的患者中，阿片类药物依赖的患病率可能高达26%。鉴于这些惊人的数据，作为护理人员，我们必须避免助长阿片类药物依赖，而是继续研究在急诊环境中用于治疗急性偏头痛的非阿片类疗法。我们的文献综述表明，与阿片类药物相比，甲氧氯普胺应更频繁地用作急性偏头痛的一线治疗药物。美国头痛协会不鼓励将阿片类药物专门用作偏头痛治疗药物，理由是“证据不足”。同样的指南将特别是使用10毫克剂量的甲氧氯普胺列为“极有可能有效”。阿片类药物的另一个主要问题是滥用的可能性越来越大，因此总体而言，仅在特殊情况下尽量减少使用这些药物将是有益的。
