Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department-Based Randomized Clinical Trial

Annals of Emergency Medicine
Benjamin W FriedmanE John Gallagher

Abstract

More than 1 million patients present to US emergency departments (EDs) annually seeking care for acute migraine. Parenteral antihistamines have long been used in combination with antidopaminergics such as metoclopramide to treat acute migraine in the ED. High-quality data supporting this practice do not exist. We determine whether administration of diphenhydramine 50 mg intravenously+metoclopramide 10 mg intravenously results in greater rates of sustained headache relief than placebo+metoclopramide 10 mg intravenously. This was a randomized, double-blind, clinical trial comparing 2 active treatments for acute migraine in an ED. Eligible patients were adults younger than 65 years presenting with an acute moderate or severe headache meeting International Classification of Headache Disorders-2 migraine criteria. Patients were stratified according to presence or absence of allergic symptoms. The primary outcome was sustained headache relief, defined as achieving a headache level of mild or none within 2 hours of medication administration and maintaining this level of relief without use of any additional headache medication for 48 hours. Secondary efficacy outcomes included mean improvement on a 0 to 10 verbal scale between baseline...Continue Reading

References

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Nov 17, 2007·Annals of Emergency Medicine·Benjamin W FriedmanE John Gallagher
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Feb 14, 2014·Neurology·Benjamin W FriedmanE John Gallagher
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Citations

Aug 12, 2016·Annals of Emergency Medicine·Benjamin W Friedman
Nov 7, 2017·Cephalalgia : an International Journal of Headache·Angela J OkraglyRobert J Benschop
Feb 17, 2018·Cephalalgia : an International Journal of Headache·Peer Tfelt-HansenThien Phu Do
Feb 15, 2020·Cephalalgia : an International Journal of Headache·Alicia AlpuentePatricia Pozo-Rosich
Apr 11, 2018·European Journal of Pain : EJP·G van AmerongenG J Groeneveld
Jun 8, 2018·Headache·Larry CharlestonUNKNOWN Underserved Populations in Headache Medicine Special Interest Section of the American Headache Society
Jul 31, 2018·Advanced Emergency Nursing Journal·Calli Cook, Brittany Newberry
Apr 30, 2019·Advanced Emergency Nursing Journal·Jennifer Jesani, Darlie Simerson
Feb 6, 2018·The Journal of Emergency Medicine·Brit J Long, Alex Koyfman
Mar 26, 2021·Neurology·Benjamin W FriedmanE John Gallagher
Jun 16, 2021·JAMA : the Journal of the American Medical Association·Juliana H VanderPluymZhen Wang

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