Double-Blind, Multicenter Trial to Compare the Efficacy of Intramuscular Dihydroergotamine Plus Hydroxyzine Versus Intramuscular Meperidine Plus Hydroxyzine for the Emergency Department Treatment of Acute Migraine Headache - 09/09/11
Abstract |
Study objective: To evaluate intramuscular dihydroergotamine in direct comparison with opioid analgesia in the treatment of acute migraine headache.
Methods: This was a prospective, multicenter, double-blind trial performed in the emergency departments of 11 general hospitals in the United States. One hundred seventy-one patients between the ages of 18 and 60 years who presented to the ED with acute migraine headache were enrolled. Patients were randomly assigned to receive either 1 mg dihydroergotamine (DHE) or 1.5 mg/kg meperidine (MEP) by intramuscular injection. The antinauseant hydroxyzine (H) was coadministered in both treatment groups.
Results: One hundred fifty-six patients were evaluable. Treatment groups were comparable in sample size, demographics, and baseline measurements of headache pain. Reduction of headache pain as measured on a 100-mm visual analog scale was 41±33 mm (53.5% reduction) for the DHE group, and 45±30 mm (55.7% reduction) for the MEP group at 60 minutes after treatment (difference=2.2%; 95% confidence interval [CI] –10%, 14.5%; P=.81). Reduction in the severity of nausea and improvement in functional ability were similar between treatment groups. Central nervous system adverse events were less common in the DHE group (DHE 23.5% versus MEP 37.6%, difference=–14.1%: 95% CI –28%, 0%). In particular, dizziness was reported less commonly with DHE than MEP (2% versus 15%, difference=–13%: 95% CI –21%, –5%).
Conclusion: In this prospective, double-blind trial of a convenience sample of ED patients randomly assigned to one of two treatment regimens, DHE and MEP were comparable therapies for acute migraine. The use of DHE avoids several problems associated with opioid analgesia, including dizziness.
[Carleton SC, Shesser RF, Pietrzak MP, Chudnofsky CR, Starkman S, Morris DL, Johnson G, Rhee KJ, Barton CW, Chelly JE, Rosenberg J, Van Valen, MK: Double-blind, multicenter trial to compare the efficacy of intramuscular dihydroergotamine plus hydroxyzine versus intramuscular meperidine plus hydroxyzine for the emergency department treatment of acute migraine headache. Ann Emerg Med August 1998;32:129-138.]
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 | From the Department of Emergency Medicine, University Hospital of Cincinnati,* Cincinnati, OH; the Department of Emergency Medicine, George Washington University,‡ Washington DC; Uniformed Services University of the Health Sciences, Bethesda, MD, and Andrews Air Force Base,§ MD; the Department of Emergency Medicine, University of Massachusetts, Worcester, MA; the UCLA Emergency Medicine Center,¶ Los Angeles, CA; the Department of Emergency Medicine, University of North Carolina,# Chapel Hill, NC; the Department of Emergency Medicine, SUNY Health Sciences Center,** Syracuse, NY; the Division of Emergency Medicine and Toxicology, University of California, Davis,‡‡ Sacramento, CA; Emergency Medicine, University of California, San Francisco,§§ San Francisco, CA; the Department of Emergency Medicine, University of Texas, Houston, Houston, TX; and Novartis Medical Operations,¶¶ East Hanover, NJ. |
| Supported by the Medical Operations Division of Novartis Pharmaceuticals Corporation, East Hanover, NJ. |
 | Reprint no.47/1/91462 |
| Address for reprints: Steven C Carleton, MD, PhD Department of Emergency Medicine University of Cincinnati Hospital 231 Bethesda Avenue Cincinnati, OH 45267-0769 513-558-5281 Fax 513-558-5791 E-mail Steven.Carleton@uc.edu |
Vol 32 - N° 2
P. 129-138 - août 1998 Retour au numéro
- Tramadol Versus Hydrocodone-Acetaminophen in Acute Musculoskeletal Pain: A Randomized, Double-Blind Clinical Trial
- Michael A Turturro, Paul M Paris, Gregory L Larkin
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