CURRENT EMERGENCY TREATMENT OF SEVERE MIGRAINE HEADACHES

Objective: To compare the efficacy of the combination of meperidine and hydroxyzine IM, versus dihydroergotamine and metoclopramide IV in the treatment of severs migraine headaches. Design: This was a randomized double-blind, double-dummy study. Setting: Established patients, whose headache had failed to respond to their usual abortive agent, were invited to an out-patient headache clinic for the study. Patients: Twenty-eight patients, diagnosed as suffering from either migraine headache or chronic daily headache, were screened on arrival to exclude life-threatening causes. Intervention: Group A (14 patients) received dihydroergotamine 1mg and metoclopramide 10mg IV and a placebo injection IM, and Group B (14 patients) received meperidine 75mg and hydroxyzine 75mg IM and a placebo injection IV. Main Outcome Measures: Patients rated their headaches on a scale of 0-3 prior to treatment and again at 30 and 60 minutes. Results: Both groups experienced improvement in headache severity. (Group A P=0.001 and Group B P=0.003). Improvement in pain scale score was greater for Group A than Group B. (P=0.006). The number of patients having a mild or no headache in Group A (13/14) was significantly greater than Group B (3/14). (P<0.001) Conclusions: The combination of dihydroergotamine and metoclopramide IV should replace the standard IM narcotic and anti-emetic as the parenteral treatment of choice for severe migraine headache.