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Sumamo Schellenberg E, Dryden DM, Pasichnyk D, et al. Acute Migraine Treatment in Emergency Settings [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Nov. (Comparative Effectiveness Reviews, No. 84.)
This publication is provided for historical reference only and the information may be out of date.
| Author, year | Non-response definition | Nonresponse data | Not pain-free data | Relevance/Conclusions | ||
|---|---|---|---|---|---|---|
| Treatment | Comparison | Treatment | Comparison | |||
| Akpunonu, 1995 | Failure of patient to achieve “meaningful relief” as defined by patient | SUM 22/88 = 25% | Placebo 31/48 = 65% | SUM 61/88 = 69% | Placebo 42/48 = 88% | NR |
| Aktas, 2011 | Requirement of rescue medication (60 minutes after initial treatment) | OND 4/30 = 13.3% | MET 1/30 = 3% | NR | NR | NR |
| Alemdar, 2007 | Failure to achieve decrease in VAS pain score by >50% of baseline value and a decrease of 4-point verbal scale score (60 minutes after initial treatment) | Tramadol 5/17 = 30% | Placebo 11/17 = 65% | Tramadol 12/17 = 71% | Placebo 15/17 = 88% | Headache recurrence within 24 hr of administration reported by 2 (16.7%) of 12 patients with pain response in the tramadol group, and 1 (16.7%) of 6 patients with pain response in the placebo group. |
| Baden, 2006 | Failure to relieve all pain by ED discharge. | NR | NR | NR | NR | NR |
| Belgrade, 1989 | Failure to achieve near-complete pain resolution (90% or greater) | MEP 22/22 = 100% BUT 16/19 = 84% | DHE 13/21 = 62% | NR | NR | NR |
| Bell, 1990 | Patient requires addition medication (outside treatment protocol). | CPZ 5/24 = 21% | LID 11/26 = 42% DHE 13/26 = 50% | CPZ 16/24 = 67% | LID 24/26 = 92% DHE 6/26 = 77% | NR |
| Bigal, 2002 | Failure to achieve pain reduction of <2 points on scale of 0 to 3 before discharge (60 minutes after initial treatment) | CPZ 12/68 = 18% | Placebo 51/60 = 85% | CPZ 24/68 = 35% | Placebo 55/60 = 92% | NR |
| Bigal, 2002 | NR | NR | Diclofenac 28/30=93% | Placebo 19/30=63% | NR Foreign language (Portugese) | |
| Blanda, 2001 | < 50% improvement in pain score or an absolute pain score >2.5cm (VAS) 5 min after treatment | LID 25/27 = 93% | Placebo 19/22 = 86% | LID 9/27 = 33% | Placebo 6/22 = 27% | It may be that patients who had more severe pain were less likely to respond (at 5 min). |
| Cabarrocas, 2001 | Failure to achieve a reduction in migraine pain from moderate or severe at baseline to mild or no pain (120 min after initial treatment) | Almotriptan 2mg: ~60% 6mg: 97% 10mg: 90% | Placebo 50% | Almotriptan 2mg: 74% 6mg: 41% 10mg: 61% | Placebo 75% | NR |
| Cady, 1991 | Requirement of rescue medication | SUM 20% | Placebo 59% | SUM 223/734 = 30% | Placebo 290/370 = 78% | NR |
| Callaham, 1986 | Requirement of rescue narcotics | DHE 0/19 = 0% | Placebo 4/15 = 27% | NR | NR | No factors correlated with treatment success. |
| Callan, 2008 | Requirement of rescue medication 60 min after initial treatment (Failure to achieve improvement of 25mm on VAS scale) | PMZ 12/35 = 34% | PC 12/35 = 34% | NR | NR | NR |
| Cameron, 1995 | Failure of patient to achieve >70% relief (Requirement of rescue medication) | CPZ 10/47 = 26% | MET 15/44 = 33% | CPZ 35/47 = 74% | MET 33/44 = 75% | NR |
| Carleton, 1998 | Need for second treatment | DHE 30/85 = 39% | MEP 31/85 = 41% | NR | NR | NR |
| Requirement of rescue medication | DHE 16/85 = 19% | MEP 14/85 = 16% | NR | NR | NR | |
| Cete, 2004 | Requirement of rescue medication (30 min after initial treatment) | MEP 14/37=38% MgSO4 16/36 =44% | Placebo 26/40 = 65% | NR | NR | NR |
| Cicek, 2004 | Required rescue medication (60 min after initial treatment) | MET 12/85 = 14% PET 35/84 = 42% | MET+PET 23/84 = 27% Placebo 52/83 =63% | NR | NR | NR |
| Coppola, 1995 | Failure to achieve patient satisfaction and either a decrease of >50% in the 30-min pain score (compared with the initial score) or an absolute pain score of 2.5 cm or less. | MET 52% PC 18% | Placebo 71% | MET 6/24 = 25% PC 2/22 = 9% | Placebo 15/24 = 63% | NR |
| Corbo, 2001 | Failure to obtain a 50% pain reduction (45 minutes after initial treatment) | MET+MgSO4 6/21 = 29% | MET+placebo 1/23 = 4% | NR | NR | NR |
| Davis, 1995 | < 4 unit change in pain score (on 10-point Borg scale) | MEPT/PMZ 7/22 = 32% | Ketorolac 9/20 = 45% | NR | NR | Quotation: if the patient’s headache pain is reduced within 30 to 60 min, the patient can be given relatively good assurance that the migraine headache will continue to be suppressed for hours. |
| Demirkaya, 2001 | Failure to reduce headache pain from medium or severe to none or mild (30 min after initial treatment) | MgSO4 0/15 = 0% | Placebo 14/15 = 93% | MgSO4 2/15 =13.4% | Placebo 15/15 = 100% | NR |
| Donaldson, 2008 | Failure to resolve headache in ED | NR | NR | DEX 30/57 = 53% | Placebo 27/42 = 64 % | NR |
| Drotts, 1999 | NR | NR | NR | NR | NR | NR |
| Duarte, 1992 | Patient fails to achieve “complete” or “great deal” of relief | KET 10/25 = 40% | MEP/HYD 11/25 = 44% | KET 24/25 = 96% | MEP/HYD 25/25 = 100% | NR |
| Edwards, 2001 | Failure to achieve headache relief (from moderate to severe to mild or no headache) within 4 hr | VAL 40% | MET+DHE 40% | NR | NR | NR |
| Engindeniz, 2005 | Failure to achieve headache relief (from pain score of 2 or 3 to 0 or 1) within 2 hr | Diclofenac sodium 4/20 = 20% | Tramadol 4/20 = 20% | Diclofenac sodium 11/20 = 55% | Tramadol 13/20 = 65% | NR |
| Fiesseler, 2011 | Failure to resolve headache at 24 hr FU | DEX 15/46 = 33% Prednisone 18/48 = 38% | Placebo 36/82 = 44% | DEX (At D/C) 81/94 = 86% | Placebo (At D/C) 77/87 = 89% | NR |
| Frank, 2004a | <50% reduction in VAS pain score | MgSO4 17/21 = 81% | Placebo 16/21 = 76% | NR | NR | NR |
| Frank, 2004b | Patients requiring rescue therapy. | MgSO4 17/21 = 81% | Placebo 18/21 = 86% | NR | NR | NR |
| Friedman, 2005 | Required rescue medication | MET/DPH 2/40 = 5% | SUM 10/38 = 26% | MET/DPH 16/40= 41% | SUM 24/38 = 65% | NR |
| Friedman, 2006 | Failure to achieve mild or no headache pain at 2 hr post-treatment (required rescue medication) | TMB+DPH 4/20 = 20% | SUM 3/20 = 15% | TMB/DPH 14/20 = 70% | SUM 11/20 = 55% | NR |
| Friedman, 2007 | Requirement of rescue medication | MET+DEX 14/106 = 13% | MET+Placebo 13/99 = 13% | MET+DEX 48/106 = 45% | MET+Placebo 52/99 = 53% | In the H/A > 72 hr subgroup, 38% of those receiving dexamethasone were persistently pain free vs 13% of placebo (p = 0.06). |
| Friedman, 2008 | Required rescue medication (60 min after initial treatment) | PCZ 3/34 = 9% | MET 6/36 = 17% | PCZ 16/37 = 43% | MET 22/37 = 59% | Logistic regression analysis showed that duration of headache did not influence the 1-hr outcome (R2 = 0.00; P= 0.73). |
| Ginder, 2000 | Partial (<45%) or no pain relief and requirement of additional pain medication | PCZ 10/20 = 50% | MgSO4 8/16 = 50% | PCZ 12/20 = 60% | MgSO4 14/16 = 88% | NR |
| Hill, 2008a | Failure to reduce pain from moderate or severe to mild or none (60 min after initial treatment) | Olanzapine 6/44 = 13.6% | DRO 5/40 = 12.5% | Olanzapine 28/45 =62% | DRO 31/45 =69% | NR |
| Hill, 2008b | Required rescue medication | Olanzapine 4/45 = 9% | DRO 6/42 =14% | (See above) | (see above) | NR |
| Hoag, 1986 | Failure to achieve improvement above the median relief score of 2.2 | MTP 30% | MEP+DHE 72% | NR | NR | NR |
| Honkaniemi, 2006 | Failure to achieve “significant relief” within 3 hr of treatment | Haloperidol 4/20 = 20% | Placebo 17/20 = 85% | NR | NR | NR |
| Innes, 1999 | Patients requiring > 1 abortive treatment. | DEX 25/49 = 51% | Placebo 26/49 = 53% | NR | NR | Post-hoc regression analysis showed an association between increased headache duration and severe recurrent headache, suggesting that the relative risk of recurrent severe headache increases by about 1%/hr of headache duration. |
| Jones, 1989 | Any patient without relief (60 minutes after initial treatment) | PCZ 5/42 = 12% | Placebo 22/40 = 55% | PCZ 31/42 = 74% | Placebo 5/40 = 13% | Patients (treatment, and placebo) who achieved complete relief in the ED had no recurrence of headache within 48 hrs. |
| Jones, 1996 | Required rescue analgesic (60 minutes after initial treatment) | PCZ 16/28 = 57% MET 23/29 = 79% | Placebo 25/29 = 86% | PCZ 19/28 = 68% MET 25/29 = 86% | Placebo 27/29 = 93% | |
| Jones, 2003 | NR | NR | Abstract | |||
| Jovicic, 1995 | NR | NR | NR | NR | Foreign language | |
| Karachallios, 1992 | Failure to achieve complete pain relief | Diclofenac sodium 5/45 = 12% | Paracetamol 33/40 = 82.5% | Diclofenac sodium Same result | NR | NR |
| Kelly, 1997 | Failure to relieve pain to patient satisfaction | SUM 1/20 = 5% | CPZ 1/23 = 4% | SUM 58% | CPZ 59% | NR |
| Klapper, 1986 | Pain improvement of <1 pain unit, and patient felt unable to return to normal functioning | DEX+MET 5/11 = 46% DHE+MET 4/9 = 44% | Placebo 0/10 = 0% | NR | NR | NR |
| Klapper, 1991 | Moderate pain and requirement of rescue medication (60 min after initial treatment) | KET 6/9 = 67% | DHE+MET 0/8 = 0% | NR | ||
| Kostic, 2010 | NR | NR | NR | NR | NR | |
| Krymchantowski, 2003 | Requirement of rescue medication (120 min after initial treatment) | LC 1/17 = 6% | Placebo 6/12 = 50% | LC 3/17 = 18% | Placebo 7/12 = 58% | NR |
| Lane, 1989 | Requirement of rescue medication after 3 treatments (45 min after initial treatment) | CPZ 2/24 = 8% | MEP+DHE 11/22 = 50% | NR | NR | NR |
| Larkin, 1992 | Requirement of rescue medication | KET 11/15 = 73% | MEP 6/16 = 36% | KET 14/15 = 95% (Figure 2) | MEP 11/16 = 70% (Figure 2) | NR |
| Limroth, 1999 | Pain relief of less than 50% (60 min after initial treatment) | L-ASA 31/56 = 55% | Ergot 43/56 = 77% | NR | NR | NR |
| McEwen, 1987 | Requirement of rescue medication | CPZ 8/19 = 42% | Placebo 14/17 = 82% | CPZ 18/19 = 95% | Placebo 17/17 = 100% | NR |
| Meredith, 2003 | Requirement of rescue medication at end of study period | SUM 4/16 = 25% | KET 2/13 = 15% | NR | NR | NR |
| Miller, 2009 | Failure to achieve patient satisfaction with treatment and either a decrease of 50% or more in the pain score when compared with the initial score or an absolute pain score of 2.5 cm or less (Required rescue medication) | PCZ 2/20 = 10% | OC 11/23 = 48% | NR | NR | NR |
| Miner, 2001 | Failure to obtain least a 50% reduction from their baseline VAS scores (60 min after initial treatment) | DRO 8/82 = 98% | PCZ 27/86 = 31% | NR | NR | NR |
| Monzillo, 2004 | NR | NR | Haloperidol 0/14=0% | DEX 13/15 = 53.4% | NR Foreign language | |
| Mushet, 1996 | Pain reduction of <2 points on scale of 0 to 3 (60 min after initial treatment) | SUM Study 1: 30% Study 2: 23% | Placebo Study 1: 75% Study 2: 68% | SUM -120 mins Study 1: ~40% Study 2: ~44% (Figure) | Placebo -120 mins Study 1: ~91% Study 2: ~90% (Figure) | NR |
| Richman, 2002 | Patient not well enough to go home after 30 min and thus requiring rescue medication | DRO 33% | MEP 43% | NR | NR | NR |
| Rowe, 2007 | score of > 2 on the VAS scale at the end of treatment (which varied) | DEX 24/64 = 38% | Placebo 23/62 = 37% | NR | NR | VAS >2 at end of treatment had more relapse than responders (~38% vs ~20%) |
| Seim, 1998 | Requirement of rescue treatment (60 min after initial treatment) | PCZ 6/35 = 17% | KET 4/29 = 14% | NR | NR | NR |
| Shresta, 1997 | Requirement of rescue medication (120 min after initial treatment) | KET 1/15 = 7% | CPZ 2/15 = 13% | KET 6/15 = 40% | CPZ 6/15 = 40% | NR |
| Stiell, 1991 | Failure of patient to achieve >70% relief, requiring rescue medication | MEP/DHE 27.0% | MTZ 29.7% | NR | NR | NR |
| Tanen, 2003 | Requirement of rescue medication (60 min after initial treatment) | VAL 15/19 = 79% | PCZ 5/20 = 25% | NR | NR | NR |
| Tek, 1990 | “No relief of pain” | MET 8/24 = 33% | Placebo 21/26 = 81% | NR | NR | NR |
| Tek, 1987 | Requirement of rescue medication | NR | NR | NR | NR | NR |
| Thomson, 1993a | Failure to achieve significant improvement in pain (i.e. grade 2 or 3 to grade 0 or 1) within 30 min | SUM 10/28 = 36% | Placebo 16/22 = 73% | SUM 23/28 = 82% (30 minutes) | Placebo 21/22 = 95% (30 minutes) | NR |
| Thomson, 1993b | Patients requiring rescue therapy | SUM 9/28 = 32% | Placebo 17/22 = 75% | (See above) | (See above) | NR |
| Vinson, 2001 | NR | NR | NR | NR | NR | |
| Weaver, 2004 | Failure to achieve 50% pain relief (30 min after initial treatment) | DRO 8/48 = 17% | PCZ 34/47 = 28% | DRO 22/48 = 46% | PCZ 29/47 = 62% | NR |
| Wendt, 2006 | Failure to reduce moderate or severe pain to mild or no pain (120 min after initial treatment) | SUM 30% | Placebo 78% | SUM 50% | Placebo 89% | NR |
| Winner, 1996a | Failure to achieve relief by 3 hr (i.e. required rescue mediation) | DHE 20/145 = 14% | SUM 15/150 = 10% | DHE 27/145 = 19% | SUM 46/150 = 30% | NR |
| Winner, 1996b | Patients requiring rescue therapy | DHE 43/145 = 30% | SUM 23/150 = 15% | (See above) | (See above) | NR |
BUT: Butorphanol; CPZ: chlorpromazine; DHE: Dihydroergotamine; DEX: Dexamethasone; DPH Diphenhydramine; DRO: Droperidol; DiNa: diclofenac sodium; Ergot: Ergotamine; HDZ: Hydroxyzine; KET: Ketorolac; L-ASA: Lysine-Acetylsalicylic Acid; LC: Lysine Clonixinate; LID: Lidocaine; MEP: Meperidine; MgSO4: Magnesium sulphate; MTP: Metroclopamide; MTZ: Methotrimeprazine; NR = not reported; OC: Octreotide; OND: Ondansetron; PCZ: Prochlorperazine; PMZ: Promethazine; SUM: Sumatripan; TMB: Trimethobenzamide; VAL: Valporate.
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