Comparative Efficacy of Magnesium Sulphate and Dexamethasone/Metoclopramide in the Treatment of Acute Migraine Headaches

Main Article Content

Khurram Zohaib
Muhammad Ilyas
Sawera Tahir
Muhammad Asif
Waqar Qamar
Faisal Shiraz
Muhammad Waseem Abbas Khan
Ayesha Saman
Aqsa Iqbal
Sonya Bashir
Obidullah

Abstract

Background: Migraine, a neurological condition characterized by intense and debilitating headaches, poses a significant public health issue affecting millions worldwide. The complexity of migraine pathophysiology often makes its management challenging. Despite various treatment modalities, the quest for the most effective and rapid relief from acute migraine episodes remains a pertinent concern in clinical practice.


Objective: This study aimed to compare the efficacy of magnesium sulfate and a combination of dexamethasone/metoclopramide in treating acute migraine headaches to identify the most effective treatment option for rapid pain relief.


Methods: This randomized controlled trial was conducted at the Department of Emergency Medicine, Benazir Bhutto Hospital, Rawalpindi, over six months from November 25, 2015, to May 24, 2016. A total of 70 patients were enrolled, with 35 patients assigned to Group A and 35 to Group B. Group A received 1g of magnesium sulfate in 100ml normal saline over 15 minutes, while Group B received 8mg of dexamethasone and 10mg of metoclopramide in a similar saline solution and infusion time. Pain severity was assessed using the Numeric Rating Scale (NRS) at baseline and two hours after medication administration. Data were analyzed using SPSS Version 25, with mean ± standard deviation calculated for age and NRS scores. Frequency and percentages were computed for gender and efficacy. Efficacy between the groups was compared using Chi-square tests, and stratification was applied to control for age and gender, followed by post-stratification Chi-square testing. A p-value of ≤ 0.05 was considered statistically significant.


Results: The results showed a significant difference in pain relief between the two groups. In Group A, 23 patients (65.7%) reported significant pain relief compared to 13 patients (34.3%) in Group B (p=0.017). Stratification by age revealed that in patients under 30 years, 11 patients (31.4%) in Group A experienced pain relief compared to 8 patients (22.9%) in Group B (p=0.202). For patients over 30 years, 12 patients (34.3%) in Group A reported pain relief, compared to 5 patients (14.3%) in Group B (p=0.084). Gender stratification showed that among males, 5 (14.3%) in Group A experienced pain relief compared to 9 (25.7%) in Group B (p=0.408), while among females, 18 (51.4%) in Group A reported pain relief compared to 4 (11.4%) in Group B (p=0.000).


Conclusion: Magnesium sulfate was found to be a more effective and faster-acting medication compared to a combination of dexamethasone and metoclopramide for the treatment of acute migraine headaches. This finding highlights the potential of magnesium sulfate as a preferred option for rapid pain relief in clinical settings, particularly for female patients.

Article Details

How to Cite
Zohaib, K., Ilyas, M., Tahir, S., Asif, M., Qamar, W., Shiraz, F., Khan, M. W. A., Saman, A., Iqbal, A., Bashir, S., & Obidullah. (2024). Comparative Efficacy of Magnesium Sulphate and Dexamethasone/Metoclopramide in the Treatment of Acute Migraine Headaches. Journal of Health and Rehabilitation Research, 4(2), 685–689. https://doi.org/10.61919/jhrr.v4i2.857
Section
Articles
Author Biographies

Khurram Zohaib, Benazir Bhutto Hospital Rawalpindi Pakistan.

Medical Officer, Department of Medicine, Benazir Bhutto Hospital, Rawalpindi, Pakistan.

Muhammad Ilyas, Lady Reading Hospital Peshawar Pakistan.

Postgraduate Resident, Department of Medicine, Lady Reading Hospital, Peshawar, Pakistan.

Sawera Tahir, Shaukat Khanum Hospital Lahore Pakistan.

Medical Officer, Department of Medicine, Shaukat Khanum Hospital, Lahore, Pakistan.

Muhammad Asif, Benazir Bhutto Hospital Rawalpindi Pakistan.

Registrar, Department of Medicine, Benazir Bhutto Hospital, Rawalpindi, Pakistan.

Waqar Qamar, Benazir Bhutto Hospital Rawalpindi Pakistan.

Postgraduate Resident, Department of Medicine, Benazir Bhutto Hospital, Rawalpindi, Pakistan.

Faisal Shiraz, THQ Hospital Kotli Sattian Pakistan.

Medical Specialist/Consultant Physician, Department of Medicine, THQ Hospital Kotli Sattian, Pakistan.

Muhammad Waseem Abbas Khan, Benazir Bhutto Hospital Rawalpindi Pakistan.

Postgraduate Resident, Department of Medicine, Benazir Bhutto Hospital, Rawalpindi, Pakistan.

Ayesha Saman, Benazir Bhutto Hospital Rawalpindi Pakistan.

Postgraduate Resident, Department of Medicine, Benazir Bhutto Hospital, Rawalpindi, Pakistan.

Aqsa Iqbal, Benazir Bhutto Hospital Rawalpindi Pakistan.

Postgraduate Resident, Department of Medicine, Benazir Bhutto Hospital, Rawalpindi, Pakistan.

Sonya Bashir, Benazir Bhutto Hospital Rawalpindi Pakistan.

Postgraduate Resident, Department of Medicine, Benazir Bhutto Hospital, Rawalpindi, Pakistan.

Obidullah, Benazir Bhutto Hospital Rawalpindi Pakistan.

Postgraduate Resident, Department of Medicine, Benazir Bhutto Hospital, Rawalpindi, Pakistan.

References

Amiri P, Kazeminasab S, Nejadghaderi SA, Mohammadinasab R, Pourfathi H, Araj-Khodaei M, et al. Migraine: A Review on Its History, Global Epidemiology, Risk Factors, and Comorbidities. Front Neurol. 2022;2553.

Agostoni EC, Barbanti P, Calabresi P, Colombo B, Cortelli P, Frediani F, et al. Current and Emerging Evidence-Based Treatment Options in Chronic Migraine: A Narrative Review. J Headache Pain. 2019;20:1-9.

Gur STA, Ahiskalioglu EO, Aydin ME, Kocak AO, Aydin P, Ahiskalioglu A. Intravenous Lidocaine vs. NSAIDs for Migraine Attack in the ED: A Prospective, Randomized, Double-Blind Study. Eur J Clin Pharmacol. 2022;1-7.

De Baaij JH, Hoenderop JG, Bindels RJ. Magnesium in Man: Implications for Health and Disease. Physiol Rev. 2015;95:1-46.

Wolf MT. Inherited and Acquired Disorders of Magnesium Homeostasis. Curr Opin Pediatr. 2017;29:187-193.

Workinger JL, Doyle RP, Bortz J. Challenges in the Diagnosis of Magnesium Status. Nutrients. 2018;10:1202.

Kirkland AE, Sarlo GL, Holton KF. The Role of Magnesium in Neurological Disorders. Nutrients. 2018;10:730.

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.

Corbo J, Esses D, Bijur PE, Iannaccone R, Gallagher EJ. Randomized Clinical Trial of Intravenous Magnesium Sulfate as an Adjunctive Medication for Emergency Department Treatment of Migraine Headache. Ann Emerg Med. 2001;38:621-627.

Franjic L. Review of the Typical and Atypical Treatment Options for Acute Migraine Headache in the Emergency Department. Curr Emerg Hosp Med Rep. 2016;4:46-51.

Talebian MT, Mirbaha S, Davarinezhad-Moghadam E, Payandemehr P. Comparing the Therapeutic Effects of Dexamethasone-Metoclopramide with Ketorolac in Relieving Headache in Patients with Acute Migraine Attacks Presenting to the Emergency Department. Adv J Emerg Med. 2019;3:1-7.

Mukherjee D, Coates PJ, Lorimore SA, Wright EG. Responses to Ionizing Radiation Mediated by Inflammatory Mechanisms. J Pathol. 2014;232:289-299.

Vécsei L, Szok D, Nyári A, Tajti J. Treating Status Migrainosus in the Emergency Setting: What Is the Best Strategy? Expert Opin Pharmacother. 2018;19:1523-1531.

Ungrungseesopon N, Wongtanasarasin W. Pain Reduction and Adverse Effects of Intravenous Metoclopramide for Acute Migraine Attack: A Systematic Review and Meta-Analysis of Randomized-Controlled Trials. World J Methodol. 2022;12:319.

Latev A, Friedman BW, Irizarry E, Solorzano C, Restivo A, Chertoff A, et al. A Randomized Trial of a Long-Acting Depot Corticosteroid Versus Dexamethasone to Prevent Headache Recurrence Among Patients with Acute Migraine Who Are Discharged from an Emergency Department. Ann Emerg Med. 2019;73:141-149.

Gupta VK, Block S. Abortive Therapies for Migraine: A Mechanistic Review. Indian J Pharmacol. 2019;51:16-22.

Jouryabi AM, Sharami SH, Ghanaie MM, Sedighinejad A, Imantalab V, Sorouri ZR, et al. Comparing the Effects of Low Dose of Ketamine, Tramadol, and Ondansetron in Prevention of Post Spinal Anesthesia Shivering in Cesarean Section. Anesth Pain Med. 2021;11:1-5.

Tfelt-Hansen P, Pascual J, Ramadan N, Dahlöf C, D'Amico D, Diener HC, et al. Guidelines for Controlled Trials of Drugs in Migraine: A Guide for Investigators. Cephalalgia. 2012;32:6-38.

Nandhini J, Karthikeyan E, Rajeshkumar S. Nanomaterials for wound healing: Current status and futuristic frontier. Biomedical Technology. 2024 Jun 1;6:26-45.

Tomcic A. Psychoanalysis at Hawkspur Camp and other Therapeutic Communities for Antisocial Children and Young People. Psychoanalysis and History. 2024 Mar 11.

Most read articles by the same author(s)

<< < 1 2