Intravenous caffeine versus intravenous ketorolac for the management of moderate to severe migraine headache

Authors

  • Alireza Baratloo Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran
  • Sara Arab Bafarani Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran
  • Mohammad Mehdi Forouzanfar Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran
  • Behrooz Hashemi Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran
  • Benjamin Wolkin Friedman Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
  • Ali Abdalvand Department of Emergency Medicine, University of Calgary, Calgary, AB

DOI:

https://doi.org/10.3329/bjp.v11i2.26333

Keywords:

Migraine Headache, Ketorolac, Caffeine, Pain Management, Emergency Department

Abstract

The aim of this study was to determine if intravenous caffeine is as effective as intravenous ketorolac for the treatment of moderate to severe migraine headaches. Eligible patients randomly received 60 mg caffeine citrate or 60 mg ketorolac infused intravenously. Their pain score were measured at baseline, one hour and two hours after infusion. Therapeutic success was defined as decreasing of at least 3 points on the pain score. In total 110 patients were enrolled (75.5% women). Therapeutic success after 60 min was achieved by 63.6% of patients in the caffeine and 70.1% of patients in the ketorolac group (p = 0.23). After 120 min, 87.3% of the caffeine group and 83.6% of the ketorolac group achieved therapeutic success (p = 0.49). In this multi-center, randomized double blind study, intravenous caffeine was as effective as intravenous ketorolac for first line abortive management of acute migraine.

 

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References

Alschuler KN, Jensen MP, Ehde DM. Defining mild, moderate, and severe pain in persons with multiple sclerosis. Pain Med. 2012; 13: 1358-65.

Baratloo A, Amiri M, Forouzanfar MM, Hasani S, Fouda S, Negida A. Efficacy measurement of ketorolac in reducing the severity of headache. J Emerg Pract Trauma. 2016; 2: 21-24.

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: 125-29.

Baratloo A, Rouhipour A, Forouzanfar MM, Safari S, Amiri M, Negida A. The role of caffeine in pain management: A brief literature review. Anesthesiol Pain Med. 2015; (in press).

Coppola M, Yealy DM, Leibold RA. Randomized, placebo-controlled evaluation of prochlorperazine versus metoclo-pramide for emergency department treatment of migraine headache. Ann Emerg Med. 1995; 26: 541-46.

Friedman BW, Garber L, Yoon A, Solorzano C, Wollowitz A, Esses D, Gallagher EJ. Randomized trial of IV valproate vs metoclopramide vs ketorolac for acute migraine. Neurology 2014; 82: 976-83.

Goldstein J, Hagen M, Gold M. Results of a multicenter, double-blind, randomized, parallel-group, placebo-controlled, single-dose study comparing the fixed combination of acetaminophen, acetylsalicylic acid and caffeine with ibuprofen for acute treatment of patients with severe migraine. Cephalalgia 2014; 34: 1070-78.

Jensen MP, Smith DG, Ehde DM, Robinsin LR. Pain site and the effects of amputation pain: Further clarification of the meaning of mild, moderate and severe pain. Pain 2001; 91: 317-22.

Kelly A. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J. 2001; 18: 205-07.

Lipton RB, Stewart WF, Ryan, RE, Saper J, Silberstein S, Sheftell F. Efficacy and safety of acetaminophen, aspirin and caffeine in alleviating migraine headache pain: Three double-blind, randomized, placebo-controlled trials. Arch Neurol. 1998; 55: 210-17.

Mark M, Au T, Choi Y, Wong T. The minimum clinically significant difference in visual analogue scale pain score in a local emergency setting. Hong Kong J Emerg Med. 2009; 16: 233-36.

Meredith JT, Wait S, Brewer KL. A prospective double-blind study of nasal sumatriptan versus IV ketorolac in migraine. Am J Emerg Med. 2003; 21: 173-75.

Monda VD, Nicolodi M, Aloisio A, Bianco PD, Fonzari M, Grazioli I, Sicuteri F. Efficacy of a fixed combination of indomethacin, prochlorperazine and caffeine versus sumatriptan in acute treatment of multiple migraine attacks: A multicenter, randomized, cross-over trial. Headache J Head Face Pain. 2003; 43: 835-44.

Natoli JL, Manack A, Dean B, Butler Q, Turkel CC, Stovner L, Lipton, RB. Global prevalence of chronic migraine: A systematic review. Cephalalgia 2010; 30: 599-609.

Pini LA, Guerzoni S, Cainazzo M, Ciccarese M, Prudenzano MP, Livrea P. Comparison of tolerability and efficacy of a combination of paracetamol + caffeine and sumatriptan in the treatment of migraine attack: A randomized, double-blind, double-dummy, cross-over study. J Headache Pain. 2012; 13: 669-75.

Rogers NL, Dinges DF. Caffeine: Implications for alertness in athletes. Clinics Sports Med. 2005; 24: 1-13.

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: 69-76.

Taggart E, Doran S, Kokotillo A, Campbell S, Villa?Roel C, Rowe BH. Ketorolac in the treatment of acute migraine: A systematic review. Headache J Head Face Pain. 2013; 53: 277-87.

Zelman DC, Dukes E, Brandenburg N, Bostrom A, Gore M. Identification of cut-points for mild, moderate and severe pain due to diabetic peripheral neuropathy. Pain 2005; 115: 29-36.

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Published

2016-04-02

How to Cite

Baratloo, A., S. A. Bafarani, M. M. Forouzanfar, B. Hashemi, B. W. Friedman, and A. Abdalvand. “Intravenous Caffeine Versus Intravenous Ketorolac for the Management of Moderate to Severe Migraine Headache”. Bangladesh Journal of Pharmacology, vol. 11, no. 2, Apr. 2016, pp. 428-32, doi:10.3329/bjp.v11i2.26333.

Issue

Vol. 11 No. 2 (2016)

Section

Clinical Trial

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