Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Jul 20, 2022; 12(4): 319-330
Published online Jul 20, 2022. doi: 10.5662/wjm.v12.i4.319
Pain reduction and adverse effects of intravenous metoclopramide for acute migraine attack: A systematic review and meta-analysis of randomized-controlled trials
Nat Ungrungseesopon, Wachira Wongtanasarasin
Nat Ungrungseesopon, Wachira Wongtanasarasin, Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
Wachira Wongtanasarasin, Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA
Author contributions: Ungrungseesopon N and Wongtanasarasin W designed the protocol, contributed to data collection and analysis, and wrote the first draft of the manuscript; Wongtanasarasin W edited and revised the manuscript; both authors read and critically reviewed the final version of the manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2021 Checklist, and the manuscript was prepared and revised according to the PRISMA 2021 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wachira Wongtanasarasin, MD, Attending Doctor, Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, 110 Intavarorot Street, Sriphum, Chiang Mai 50200, Thailand. wachir_w@hotmail.com
Received: February 4, 2022
Peer-review started: February 4, 2022
First decision: April 11, 2022
Revised: April 26, 2022
Accepted: July 11, 2022
Article in press: July 11, 2022
Published online: July 20, 2022
Processing time: 165 Days and 12.9 Hours
Abstract
BACKGROUND

Metoclopramide may be used to treat people suffering from acute migraine. However, no comprehensive investigation on this issue has been recorded. This review will provide more solid evidence for the use of metoclopramide in treating acute migraine.

AIM

To compare the efficacy of intravenous metoclopramide with other therapies in migraine attack treatment in an emergency department (ED).

METHODS

We included randomized controlled trials of participants older than 18 years with acute migraine headaches, which included at least one arm that received intravenous (IV) metoclopramide at the ED. A literature search of PubMed, Web of Science, Cochrane Collaboration, and Reference Citation Analysis on December 31, 2021 retrieved other drugs or placebo-controlled studies without language limitation. The risk of bias was assessed using the Cochrane risk of bias tool. The primary endpoint was pain reduction at 60 min or closest to 1 h after treatment, as measured by the pain scale. Secondary endpoints included adverse effects or reactions resulting from metoclopramide or comparisons.

RESULTS

Fourteen trials with a total of 1661 individuals were eligible for review. The risk of bias ranged from low to intermediate. IV metoclopramide administration was not associated with higher pain reduction at 1 h (Standard mean difference [SMD] = -0.03, 95% confidence interval [CI]: -0.33-0.28, P = 0.87). However, metoclopramide was associated with better pain reduction than placebo (SMD = 1.04, 95%CI: 0.50-1.58, P = 0.0002). In addition, side effects were not significantly different between IV metoclopramide and other drugs or placebo (odds ratio [OR] = 0.76, 95%CI: 0.48-1.19, P = 0.09 and OR = 0.92, 95%CI: 0.31-2.74, P = 0.54, respectively).

CONCLUSION

Metoclopramide is more effective than placebo in treating migraine in the ED. Despite the observed tendency of decreased side effects, its effectiveness compared to other regimens is poorly understood. More research on this area is needed to treat migraine in acute care settings effectively.

Keywords: Metoclopramide; Migraine; Efficacy; Adverse effect; Randomized controlled trials

Core Tip: Metoclopramide may be used to treat people suffering from acute migraine. However, no comprehensive investigation on this issue has been recorded. We conducted an up-to-date systematic review and meta-analysis of the clinical efficacy of metoclopramide during an acute migraine attack. This study comprised 14 studies and found that metoclopramide was more effective than placebo in treating migraine at the emergency department. When compared to other medications, however, no substantial advantage was detected. More study is needed to enhance migraine therapy in acute care settings effectively.