Canadian Headache Society systematic review and recommendations on the treatment of migraine pain in emergency settings

Serena L. Orr, Michel Aubé, Werner J. Becker, W. Jeptha Davenport, Esma Dilli, David Dodick, Rose Giammarco, Jonathan Gladstone, Elizabeth Leroux, Heather Pim, Garth Dickinson, Suzanne N. Christie

Research output: Contribution to journalReview article

46 Scopus citations

Abstract

Background: There is a considerable amount of practice variation in managing migraines in emergency settings, and evidence-based therapies are often not used first line. Methods: A peer-reviewed search of databases (MEDLINE, Embase, CENTRAL) was carried out to identify randomized and quasi-randomized controlled trials of interventions for acute pain relief in adults presenting with migraine to emergency settings. Where possible, data were pooled into meta-analyses. Results: Two independent reviewers screened 831 titles and abstracts for eligibility. Three independent reviewers subsequently evaluated 120 full text articles for inclusion, of which 44 were included. Individual studies were then assigned a US Preventive Services Task Force quality rating. The GRADE scheme was used to assign a level of evidence and recommendation strength for each intervention. Interpretation:We strongly recommend the use of prochlorperazine based on a high level of evidence, lysine acetylsalicylic acid, metoclopramide and sumatriptan, based on a moderate level of evidence, and ketorolac, based on a low level of evidence. We weakly recommend the use of chlorpromazine based on a moderate level of evidence, and ergotamine, dihydroergotamine, lidocaine intranasal and meperidine, based on a low level of evidence. We found evidence to recommend strongly against the use of dexamethasone, based on a moderate level of evidence, and granisetron, haloperidol and trimethobenzamide based on a low level of evidence. Based on moderate-quality evidence, we recommend weakly against the use of acetaminophen and magnesium sulfate. Based on low-quality evidence, we recommend weakly against the use of diclofenac, droperidol, lidocaine intravenous, lysine clonixinate, morphine, propofol, sodium valproate and tramadol.

Original languageEnglish (US)
Pages (from-to)271-284
Number of pages14
JournalCephalalgia
Volume35
Issue number3
DOIs
StatePublished - Mar 26 2015

Keywords

  • Migraine
  • acute pain
  • emergency
  • headache
  • management

ASJC Scopus subject areas

  • Clinical Neurology

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    Orr, S. L., Aubé, M., Becker, W. J., Davenport, W. J., Dilli, E., Dodick, D., Giammarco, R., Gladstone, J., Leroux, E., Pim, H., Dickinson, G., & Christie, S. N. (2015). Canadian Headache Society systematic review and recommendations on the treatment of migraine pain in emergency settings. Cephalalgia, 35(3), 271-284. https://doi.org/10.1177/0333102414535997