Abstract | STUDY OBJECTIVE: METHODS: In this emergency department (ED)-based randomized, double-blind study, we enrolled adults with nonmigraine, noncluster recurrent headaches. Patients with tension-type headache were a subgroup of special interest. Our primary outcome was a comparison of the improvement in pain score between baseline and 1 hour later, assessed on a 0 to 10 verbal scale. We defined a between-group difference of 2.0 as the minimum clinically significant difference. Secondary endpoints included need for rescue medication in the ED, achieving headache freedom in the ED and sustaining it for 24 hours, and patient's desire to receive the same medication again. RESULTS: We included 120 patients in the analysis. The metoclopramide/ diphenhydramine arm improved by a median of 5 (interquartile range 3, 7) scale units, whereas the ketorolac arm improved by a median of 3 (IQR 2, 6) (95% confidence interval [CI] for difference 0 to 3). Metoclopramide+diphenhydramine was superior to ketorolac for all 3 secondary outcomes: the number needed to treat for not requiring ED rescue medication was 3 (95% CI 2 to 6); for sustained headache freedom, 6 (95% CI 3 to 20); and for wish to receive the same medication again, 7 (95% CI 4 to 65). Tension-type headache subgroup results were similar. CONCLUSION:
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Authors | Benjamin W Friedman, Victoria Adewunmi, Caron Campbell, Clemencia Solorzano, David Esses, Polly E Bijur, E John Gallagher |
Journal | Annals of emergency medicine
(Ann Emerg Med)
Vol. 62
Issue 4
Pg. 311-318.e4
(Oct 2013)
ISSN: 1097-6760 [Electronic] United States |
PMID | 23567060
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural)
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Copyright | Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved. |
Chemical References |
- Anti-Inflammatory Agents, Non-Steroidal
- Dopamine Antagonists
- Hypnotics and Sedatives
- Diphenhydramine
- Metoclopramide
- Ketorolac
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Topics |
- Adult
- Anti-Inflammatory Agents, Non-Steroidal
(administration & dosage, therapeutic use)
- Diphenhydramine
(administration & dosage, therapeutic use)
- Dopamine Antagonists
(administration & dosage, therapeutic use)
- Double-Blind Method
- Drug Therapy, Combination
- Female
- Headache
(drug therapy)
- Humans
- Hypnotics and Sedatives
(administration & dosage, therapeutic use)
- Infusions, Intravenous
- Ketorolac
(administration & dosage, therapeutic use)
- Male
- Metoclopramide
(administration & dosage, therapeutic use)
- Middle Aged
- Pain Management
(methods)
- Pain Measurement
- Recurrence
- Tension-Type Headache
(drug therapy)
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