TOPLINE:
For clients with migraine who check out the emergency situation department (ED), intravenous (IV) chlorpromazine offers remarkable discomfort relief at 2 hours and IV metoclopramide mixes work in preventing rescue medications, a Bayesian network meta-analysis recommends.
APPROACH:
- Scientist performed a methodical evaluation and Bayesian network meta-analysis of 64 randomized regulated trials from MEDLINE, Embase, and Web of Science databases from beginning to February 9, 2024.
- The analysis consisted of adult individuals providing to EDs with migraine, and pharmacologic treatments were compared to each other or to a placebo.
- Main results were appropriate discomfort relief at 2 hours, modification in discomfort strength at 1 hour, require for rescue drug at 2 hours, and considerable unfavorable responses.
- Scientists utilized surface area under the cumulative ranking curve (SUCRA) to rank healing representatives.
TAKEAWAY:
- Chlorpromazine IV/intramuscular (IM) showed the greatest likelihood of supremacy (SUCRA, 87.3%) for appropriate discomfort relief at 2 hours, followed by prochlorperazine IV/IM (80.99%), and propofol (68.54%). Ibuprofen IV was least efficient (2.47%).
- The metoclopramide IV-ibuprofen IV mix revealed the greatest possibility of supremacy for avoiding requirement for rescue drug (SUCRA, 94.6%), followed by metoclopramide IV-dexketoprofen IV (85.53%), and chlorpromazine IV/IM (83.30%). Valproate IV was least efficient (7.69%).
- Dexamethasone IV (SUCRA, 79.51%) became more than likely remarkable for preventing considerable unfavorable responses, followed by ketorolac IV (79.37%).
- Scientists discovered considerable disparities in the information for discomfort strength modifications at 1 hour, making the outcomes undependable and not appropriate to more comprehensive settings.
IN PRACTICE:
“Chlorpromazine IV/IM is certainly amongst the most efficient, valproate IV is certainly amongst the least efficient, and ketorolac IV/IM is potentially amongst the least reliable as single representatives preventing the requirement for rescue drug,” the authors composed. “The relative security of the pharmacologic treatments can not be figured out with enough certainty. Even more, randomized regulated trials of parenterally administered, and possibly more fairly efficient pharmacologic treatments such as chlorpromazine, prochlorperazine, and metoclopramide-NSAID [non-steroidal anti-inflammatory drug] mixes need to more robustly develop which are the very best alternatives for migraine in the ED,” they included.
SOURCE:
The research study was led by Ian S. deSouza, MD, SUNY Downstate Health Sciences University and Kings County Hospital Center, New York City. It was released online on December 13, 2024, in Records of Emergency Medicine
CONSTRAINTS:
The addition of an intravenous crystalloid bolus in some research studies might have lowered discomfort strength in scientifically dehydrated individuals, possibly pumping up the impact approximates for these interventions. Medical heterogeneity, such as distinctions in migraine type, individual demographics, and differing addition requirements, challenged the transitivity presumption in the network meta-analysis. Possible overrepresentation of the subgroup with moderate to serious discomfort might have altered the total efficiency price quotes, making the findings less generalizable to a wider population with differing discomfort levels.
DISCLOSURES:
The authors stated that the research study did not get any particular financing. One author divulged being on the speakers bureau and functioning as a specialist for AstraZeneca.
