Efficacy of Parenteral Agents to Reduce Pain in Patients with Acute Migraine in Emergency Settings: A Systematic Review

Student Researcher:
Lloyd Visser

Supervisor / Principle Investigator:
Dr. Brian Rowe

Additional Authors:
Jillian Meyer
Scott Kirkland
Dr. Daniela Junqueira
Dr. Cristina Villa-Roel

MD Class of 2021


Exacerbations of migraine headaches are common cause of presentation to the emergency department (ED). While a variety of parenteral agents are available, there is considerable variability in their effectiveness to manage pain.

Hypothesis: A hierarchy of effectiveness exists for parenteral medications administered in the ED or equivalent setting to relieve headache pain. A comprehensive search of 10 electronic databases and grey literature were conducted to supplement a previous systematic review on the effectiveness of parenteral medications for the treatment of migraine in the ED. Two independent reviewers completed study selection, quality assessment, and data extraction. Any discrepancies were resolved by third party adjudication. Relative risks (RR) with 95% confidence intervals (CIs) will be calculated using a random effects model. A Bayesian network model will be used to compare the effectiveness of all parenteral agents simultaneously in a single analysis. An updated search of 5438 potentially eligible records was completed, in which 54 studies were included. Combined with the 74 studies included in the previous review, a total of 128 articles were included in this review. The majority of the included studies were RCTs. While studies involving metoclopramide remain most common, additional studies and novel agents were identified illustrating the need for an updated review. Quality assessment and data analysis are still ongoing. This review identified novel and new parenteral therapies that have been used to treat patients with acute migraine. This review update will generate specific recommendations on the most effective parenteral therapies to relieve headache pain in acute care settings.