Ungrungseesopon Nat, Wongtanasarasin Wachira
Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA.
World J Methodol. 2022 Jul 20;12(4):319-330. doi: 10.5662/wjm.v12.i4.319.
Metoclopramide may be used to treat people suffering from acute migraine. However, no comprehensive investigation on this issue has been recorded. This review will provide more solid evidence for the use of metoclopramide in treating acute migraine.
To compare the efficacy of intravenous metoclopramide with other therapies in migraine attack treatment in an emergency department (ED).
We included randomized controlled trials of participants older than 18 years with acute migraine headaches, which included at least one arm that received intravenous (IV) metoclopramide at the ED. A literature search of PubMed, Web of Science, Cochrane Collaboration, and Reference Citation Analysis on December 31, 2021 retrieved other drugs or placebo-controlled studies without language limitation. The risk of bias was assessed using the Cochrane risk of bias tool. The primary endpoint was pain reduction at 60 min or closest to 1 h after treatment, as measured by the pain scale. Secondary endpoints included adverse effects or reactions resulting from metoclopramide or comparisons.
Fourteen trials with a total of 1661 individuals were eligible for review. The risk of bias ranged from low to intermediate. IV metoclopramide administration was not associated with higher pain reduction at 1 h (Standard mean difference [SMD] = -0.03, 95% confidence interval [CI]: -0.33-0.28, = 0.87). However, metoclopramide was associated with better pain reduction than placebo (SMD = 1.04, 95%CI: 0.50-1.58, = 0.0002). In addition, side effects were not significantly different between IV metoclopramide and other drugs or placebo (odds ratio [OR] = 0.76, 95%CI: 0.48-1.19, = 0.09 and OR = 0.92, 95%CI: 0.31-2.74, = 0.54, respectively).
Metoclopramide is more effective than placebo in treating migraine in the ED. Despite the observed tendency of decreased side effects, its effectiveness compared to other regimens is poorly understood. More research on this area is needed to treat migraine in acute care settings effectively.
甲氧氯普胺可用于治疗急性偏头痛患者。然而，尚未有关于此问题的全面调查记录。本综述将为甲氧氯普胺治疗急性偏头痛提供更确凿的证据。
比较急诊科（ED）中静脉注射甲氧氯普胺与其他疗法在偏头痛发作治疗中的疗效。
我们纳入了年龄大于18岁的急性偏头痛患者的随机对照试验，其中至少有一组在急诊科接受静脉注射（IV）甲氧氯普胺。于2021年12月31日在PubMed、科学网、Cochrane协作网和参考文献引用分析中进行文献检索，检索其他药物或安慰剂对照研究，无语言限制。使用Cochrane偏倚风险工具评估偏倚风险。主要终点是治疗后60分钟或最接近1小时时的疼痛减轻情况，通过疼痛量表测量。次要终点包括甲氧氯普胺引起的不良反应或反应，或比较结果。
共有14项试验，总计1661名个体符合综述条件。偏倚风险范围为低到中等。静脉注射甲氧氯普胺在1小时时与更高的疼痛减轻无关（标准平均差[SMD]= -0.03，95%置信区间[CI]：-0.33 - 0.28，P = 0.87）。然而，甲氧氯普胺与比安慰剂更好的疼痛减轻相关（SMD = 1.04，95%CI：0.50 - 1.58，P = 0.0002）。此外，静脉注射甲氧氯普胺与其他药物或安慰剂之间的副作用无显著差异（优势比[OR]= 0.76，95%CI：0.48 - 1.19，P = 0.09和OR = 0.92，95%CI：0.31 - 2.74，P = 0.54，分别）。
在急诊科治疗偏头痛时，甲氧氯普胺比安慰剂更有效。尽管观察到副作用有减少的趋势，但其与其他治疗方案相比的有效性尚不清楚。需要在该领域进行更多研究以有效治疗急性护理环境中的偏头痛。
