Metoclopramide is an effective migraine treatment for adults–as few as four patients need to be treated to enable one to achieve significant pain reduction. But other antiemetics may have more effect on pain and migraine-related nausea, according to Ian Colman, a postgraduate student at the University of Cambridge (England), and his colleagues.
Their metaanalysis included five studies of metoclopramide vs. placebo (263 adults); three studies of metoclopramide vs. other antiemetics (194 patients); two studies of metoclopramide vs. non-antiemetics (60 patients); and seven studies of metoclopramide combinations vs. other agents (211 patients).
The drug was almost three times as effective as placebo for pain and nausea reduction, but not as effective as other phenothiazine antiemetics (prochlorperazine and chlorpromazine). Metoclopramide compared favorably with ibuprofen and sumatriptan, but there was not enough evidence to determine relative effectiveness, the investigators said (BMJ 2004;329:1369–73).
The combination studies suggested that metoclopramide might also be effective as an adjunctive treatment. Several of those studies showed that metoclopramide combinations were similarly, and more, effective for pain relief than were the comparison regimens.
“Given its nonnarcotic and antiemetic properties, metoclopramide should be considered as a primary agent in the treatment of acute migraine in emergency departments,” they said.