Acetaminophen IV
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
I
|
Supportive (Green)
|
Analgesia
|
Patient
|
ED-MD
|
Kirkland SW, Visser L, Meyer J, et al. The effectiveness of parenteral agents for pain reduction in patients with migraine presenting to emergency settings: A systematic review and network analysis. Headache April 2024; 64(4):424-47. Medline
|
I
|
Neutral (Yellow)
|
Visual analogue scores at 15 and 30 minutes
|
Patient
|
ED-MD
|
Turkcuer I., Serinken M., Eken C., et al. Intravenous paracetamol versus dexketoprofen in acute migraine attack in the emergency department: A randomised clinical trial. Emerg Med 2014; 31(3):182-185. Medline
|
II
|
Supportive (Green)
|
Change in severity of headache using NRS
|
Patient
|
ED-MD
|
Friedman BW., Solorzano C., Esses D., et al. Treating headache recurrence after emergency department discharge: A randomized controlled trial of naproxen versus sumatriptan. Ann Emerg Med 2010; 56(1):7-17. Medline
|
Ketamine
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
I
|
Supportive (Green)
|
Improvement in pain at 30 min
|
Patient
|
ED-MD
|
Benish T, Villalobos D, Love S, Casmaer M, Hunter CJ, Summers SM, et al. The THINK (Treatment of Headache with Intranasal Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine with Intravenous Metoclopramide. J Emerg Med 2019; 56(3) 248-57. Medline
|
I
|
Neutral (Yellow)
|
Difference in NRS score reduction from baseline to 30 minutes
|
Patient
|
ED-MD
|
Etchison AR, Bos L, Ray M, McAllister KB, Mohammed M, Park B, et al. Low-dose Ketamine Does Not Improve Migraine in the Emergency Department A Randomized Placebo-controlled Trial. The western J of emergency medicine 2018; 19(6) 952-60. Medline
|
Metoclopramide
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
I
|
Supportive (Green)
|
Effectiveness of pain relief
|
Patient
|
ED-MD
|
Barleycorn D. Systematic review: Is Metoclopramide more effective than Sumatriptan in relieving pain from migraine in adults in the Emergency Department (ED) setting? Int Emerg N 2016; 27 51-5. Medline
|
I
|
Supportive (Green)
|
Improvement on VAS
|
Patient
|
ED-MD
|
Eken C. Critical reappraisal of intravenous metoclopramide in migraine attack: A systematic review and meta-analysis. Am J Emerg Med 2015; 33(3):331-7. Medline
|
I
|
Supportive (Green)
|
Pain response
|
Patient
|
ED-MD
|
Orr SL., Aube M., Becker WJ., et al. Canadian headache society systematic review and recommendations on the treatment of migraine pain in emergency settings. Cephalalgia 2015; 35(3):271-84. Medline
|
I
|
Supportive (Green)
|
Mean change in pain at 120 minutes
|
Patient
|
ED-MD
|
Richer LP, Ali S, Johnson DW, Rosychuk RJ, Newton AS, Rowe BH. A randomized trial of ketorolac and metoclopramide for migraine in the emergency department. Headache 2022; 62(6):681–9. Medline
|
I
|
Supportive (Green)
|
Decrease in pain at 60 minutes
|
Patient
|
ED-MD
|
Soltani KM, Motamed H, Eslami K, Majdinasab N, Kouti L. Randomised trial of IV metoclopramide vs IV ketorolac in treatment of acute primary headaches. Am J Emerg Med 2021; 50:376–80. Medline
|
II
|
Supportive (Green)
|
Headache reduction.
|
Patient
|
ED-MD
|
Patniyot IR, Gelfand AA. Acute Treatment Therapies for Pediatric Migraine: A Qualitative Systematic Review. Headache 2016; 56(1) 49-70. Medline
|
II
|
Neutral (Yellow)
|
ED revisit within 3 days
|
Process
|
ED-MD
|
Bachur RG., Monuteaux MC., Neuman MI. A comparison of acute treatment regimens for migraine in the emergency department. Pediatrics 2015; 135(2):232-8. Medline
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Kirkland SW, Visser L, Meyer J, et al. The effectiveness of parenteral agents for pain reduction in patients with migraine presenting to emergency settings: A systematic review and network analysis. Headache April 2024; 64(4):424-47. Medline
|
Metoclopramide plus diphenhydramine
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
I
|
Supportive (Green)
|
Improvement in pain at 30 minutes
|
Patient
|
ED-MD
|
Benish T, Villalobos D, Love S, Casmaer M, Hunter CJ, Summers SM, et al. The THINK (Treatment of Headache with Intranasal Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine with Intravenous Metoclopramide. J Emerg Med 2019; 56(3) 248-57. Medline
|
I
|
Supportive (Green)
|
Headache pain improvement
|
Patient
|
ED-MD
|
Friedman BW, Irizarry E, Cain D, Caradonna A, Minen MT, Solorzano C, Zias E, Zybert D, McGregor M, Bijur PE, Gallegher EJ. Randomized Study of Metoclopramide Plus Diphenhydramine for Acute Posttraumatic Headache. Neurology 2021; 96(18):e2323–31. Medline
|
I
|
Neutral (Yellow)
|
Headache relief within 2 hours - sustained for 48
|
Patient
|
ED-MD
|
Friedman BW, Cabral L, Adewunmi V, Solorzano C, Esses D, Bijur PE, et al. Diphenhydramine as Adjuvant Therapy for Acute Migraine An Emergency Department-Based Randomized Clinical Trial. Ann Emerg Med 2016; 67(1) 32-9.e3. Medline
|
II
|
Supportive (Green)
|
Sustained headache relief for 48 hours.
|
Patient
|
ED-MD
|
Friedman BW, Babbush K, Irizarry E, White D, John Gallagher E. An exploratory study of IV metoclopramide+diphenhydramine for acute post-traumatic headache. Am J Emerg Med 2018; 36(2) 285-9. Medline
|
NSAIDs
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
I
|
Supportive (Green)
|
Analgesia
|
Process
|
ED-MD
|
Kirkland SW, Visser L, Meyer J, et al. The effectiveness of parenteral agents for pain reduction in patients with migraine presenting to emergency settings: A systematic review and network analysis. Headache April 2024; 64(4):424-47. Medline
|
I
|
Supportive (Green)
|
Analgesic efficacy
|
Process
|
ED-MD
|
Motov S, Yasavolian M, Likourezos A, Pushkar I, Hossain R, Drapkin J, et al. Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department A Randomized Controlled Trial. Ann Emerg Med 2017; 70(2) 177-84. Medline
|
I
|
Supportive (Green)
|
Pain response
|
Patient
|
ED-MD
|
Orr SL., Aube M., Becker WJ., et al. Canadian headache society systematic review and recommendations on the treatment of migraine pain in emergency settings. Cephalalgia 2015; 35(3):271-84. Medline
|
I
|
Supportive (Green)
|
Visual analogue scores at 15 and 30 minutes
|
Patient
|
ED-MD
|
Turkcuer I., Serinken M., Eken C., et al. Intravenous paracetamol versus dexketoprofen in acute migraine attack in the emergency department: A randomised clinical trial. Emerg Med 2014; 31(3):182-185. Medline
|
I
|
Neutral (Yellow)
|
Improvement in NRS (Numerical Rating Scale) of pain following treatment.
|
Patient
|
ED-MD
|
Dogruyol S, Gur STA, Akbas I, Kocak MB, Kocak AO, Ceylan M, Tekyol D. Intravenous ibuprofen versus sodium valproate in acute migraine attacks in the emergency department: A randomized clinical trial. Am J Emerg Med 2022; 55:126–32. Medline
|
I
|
Neutral (Yellow)
|
Analgesic efficacy
|
Patient
|
ED-MD
|
Harden RN., Gracely RH., Carter T., Warner G. The placebo effect in acute headache management: Ketorolac, meperidine, and saline in the emergency department. Headache 1996; 36(6):352-6. Medline
|
I
|
Neutral (Yellow)
|
Mean pain scale reduction.
|
Patient
|
ED-MD
|
Richer LP, Ali S, Johnson DW, Rosychuk RJ, Newton AS, Rowe BH. A randomized trial of ketorolac and metoclopramide for migraine in the emergency department. Headache 2022; 62(6):681–9. Medline
|
III
|
Supportive (Green)
|
Pain reduction
|
Patient
|
ED-MD
|
Davis CP., Torre PR., Schafer NC., Dave B., Bass B. Jr. Ketorolac as a rapid and effective treatment of migraine headache: Evaluations by patients. Am J Emerg Med 1993; 11(6):573-5. Medline
|
III
|
Neutral (Yellow)
|
Pain control.
|
Patient
|
ED-MD
|
Patniyot IR, Gelfand AA. Acute Treatment Therapies for Pediatric Migraine: A Qualitative Systematic Review. Headache 2016; 56(1) 49-70. Medline
|