Effectiveness of the Concurrent Intravenous Injection of Dexamethasone and Metoclopramide for Pain Management in Patients with Primary Headaches Presenting to Emergency Department

Abstract

Introduction: Headache is a common reason for visiting emergency departments, and pain control is a major therapeutic goal in patients with headaches. Objective: The present study was conducted to examine the effectiveness of the concurrent intravenous administration of dexamethasone and metoclopramide in pain control in patients presenting to emergency departments with complaints of primary headache. Methods: This quasi-experimental study examined patients with moderate to severe headache attacks presenting to emergency departments. An 8-mg dose of dexamethasone and a 10-mg dose of metoclopramide were intravenously administered to the patients. The degree of headache was measured and recorded using the Numeric Rating Scale (NRS) upon admission and one hour and two hours after the injection. Results: A total of 51 patients with a mean age of 38.3±10.5 years participated in the study. The patients’ mean pain score was 8.4±1.3 upon admission and reduced to 6.2±2.3 one hour after the administration of the medication and to 3.1±2.9 two hours after the administration, suggesting significant reductions on both occasions (P<0.05). The therapeutic success was 39.2% one hour after the administration of the medication and 84.3% two hours after the administration. Conclusion: Based on these findings, the concurrent administration of dexamethasone and metoclopramide appears to affect the control of headache intensity in patients with primary headaches presenting to emergency departments.

1. Goldstein J, Camargo C, Pelletier A, Edlow J. Headache in United States emergency departments: demographics, work‐up and frequency of pathological diagnoses. Cephalalgia. 2006;26(6):684-90.
2. Bigal M, Bordini CA, Speciali JG. Headache in an emergency room in Brazil. Sao Paulo Med J. 2000;118(3):58-62.
3. Friedman BW, Hochberg ML, Esses D, Grosberg B, Corbo J, Toosi B, et al. Applying the International Classification of Headache Disorders to the emergency department: an assessment of reproducibility and the frequency with which a unique diagnosis can be assigned to every acute headache presentation. Ann Emerg Med. 2007;49(4):409-19. e9.
4. Balbin JEB, Nerenberg R, Baratloo A, Friedman BW. Intravenous fluids for migraine: a post hoc analysis of clinical trial data. Am J Emerg Med. 2016;34(4):713-6.
5. Vinson DR. Treatment patterns of isolated benign headache in US emergency departments. Ann Emerg Med. 2002;39(3):215-22.
6. Baratloo A, Bafarani SA, Forouzanfar MM, Hashemi B, Friedman BW, Abdalvand A. Intravenous caffeine versus intravenous ketorolac for the management of moderate to severe migraine headache. Bangladesh J Pharmacol. 2016;11(2):428-32.
7. Baratloo A, Negida A, El Ashal G, Behnaz N. Intravenous caffeine for the treatment of acute migraine: a pilot study. J Caffeine Res. 2015;5(3):125-9.
8. Czock D, Keller F, Rasche FM, Häussler U. Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids. Clin Pharmacokinet. 2005;44(1):61-98.
9. Talabi S, Masoumi B, Azizkhani R, Esmailian M. Metoclopramide versus sumatriptan for treatment of migraine headache: A randomized clinical trial. J Res Med Sci. 2013;18(8):695-8.
10. Ashina S, Portenoy RK. Intravenous treatment of migraine. Tech Reg Anesth Pain Manag. 2012;16(1):25-9.
11. Baratloo A, Mirbaha S, Delavar Kasmaei H, Payandemehr P, Elmaraezy A, Negida A. Intravenous caffeine citrate vs. magnesium sulfate for reducing pain in patients with acute migraine headache; a prospective quasi-experimental study. Korean J Pain. 2017;30(3):176-82.
12. Forouzanfar MM, Mahmoudi S, Javadzadeh HR, Baratloo A, Mahdavi NS, Hashemi B, et al. The effect of haloperidol administration on relieving cluster headache, probable role of dopaminergic pathway; a double blind clinical trial. J Med Physiol. 2016;1(2):72-7.
13. Baratloo A, Rouhipour A, Forouzanfar M, Safari S, Amiri M, Negida A. The Role of Caffeine in Pain Management: A Brief Literature Review. Anesth Pain Med. 2016;6(3):e33193.
14. Pain Assessment Scales: University of Florida; 2017. Available from: http://pami.emergency.med.jax.ufl.edu/resources/pain-assessment-scales/.
15. Fink R. Pain assessment: the cornerstone to optimal pain management. Proc (Bayl Univ Med Cent). 2000;13(3):236-9.
16. Andersson V, Bergman S, Henoch I, Wickström Ene K, Otterström-Rydberg E, Simonsson H, et al. Pain and pain management in hospitalized patients before and after an intervention. Scand J Pain. 2017;15(Supplement C):22-9.
17. Shahrami A, Assarzadegan F, Hatamabadi HR, Asgarzadeh M, Sarehbandi B, Asgarzadeh S. Comparison of therapeutic effects of magnesium sulfate vs. dexamethasone/metoclopramide on alleviating acute migraine headache. J Emerg Med. 2015;48(1):69-76.
18. Friedman B, Greenwald P, Bania T, Esses D, Hochberg M, Solorzano C, et al. Randomized trial of IV dexamethasone for acute migraine in the emergency department. Neurology. 2007;69(22):2038-44.
19. Rowe BH, Colman I, Edmonds ML, Blitz S, Walker A, Wiens S. Randomized controlled trial of intravenous dexamethasone to prevent relapse in acute migraine headache. Headache. 2008;48(3):333-40.
20. Colman I, Friedman BW, Brown MD, Innes GD, Grafstein E, Roberts TE, et al. Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ. 2008;336(7657):1359-61.
21. Singh A, Alter HJ, Zaia B. Does the Addition of Dexamethasone to Standard Therapy for Acute Migraine Headache Decrease the Incidence of Recurrent Headache for Patients Treated in the Emergency Department? A Meta‐analysis and Systematic Review of the Literature. Acad Emerg Med. 2008;15(12):1223-33.
22. Faridaalaee G, Rahmani SH, Mehryar H, Shishavan SB, Merghati SZ, Hasanloei MAV, et al. Comparison of intravenous metoclopramide and acetaminophen in primary headaches: A randomized controlled trial. Emergency. 2015;3(2):70-4.
23. Friedman B, Corbo J, Lipton R, Bijur P, Esses D, Solorzano C, et al. A trial of metoclopramide vs sumatriptan for the emergency department treatment of migraines. Neurology. 2005;64(3):463-8.
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IssueVol 1 No 1 (2017): Autumn (November) QRcode
SectionOriginal article
PMCIDPMC6548094
PMID31172058
Keywords
Dexamethasone Emergency department Headache Metoclopramide Pain control
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1.
Mirbaha S, Delavar-Kasmaei H, Shafiee E. Effectiveness of the Concurrent Intravenous Injection of Dexamethasone and Metoclopramide for Pain Management in Patients with Primary Headaches Presenting to Emergency Department. Front Emerg Med. 2017;1(1):e6.

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