Paracetamol with or without an antiemetic for acute migraine
Evidence summaries
Editors
20.5.2013
Paracetamol 1 000 mg is effective in acute migraine, and the addition of metoclopramide
10 mg gives short-term efficacy equivalent to oral sumatriptan 100 mg. Adverse events
with paracetamol do not differ from placebo.
Use paracetamol as first-line treatment in acute migraine with or without an antiemetic
for patients who are responsive to this drug.
A Cochrane review «http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD008040/frame.html»1 «Derry S, Moore RA. Paracetamol (acetaminophen) wit...»1 included 10 RCTs with a total of 2 769 participants (4 062 attacks) with migraine.
Paracetamol 1 000 mg, alone or in combination with metoclopramide, was compared with
placebo or sumatriptan 100 mg.
- Paracetamol vs. placebo (4 trials, n=1 293): For all efficacy outcomes paracetamol
was superior, when medication was taken for moderate to severe pain. Risk ratio (RR)
for being free of pain at 2 hours was 1.80 (95% CI 1.24–2.62) with NNT of 12
(7.5 to 32) (3 trials, n=717). RR for one-hour pain relief was 2.0 (95% CI 1.5 to
2.6) with NNT of 5.2 (3.8 to 8.1) (2 trials, n=635). RR for 2-hour pain relief was
1.6 (95% CI 1.3 to 1.8), giving an NNT 5.0 (95% CI 3.7 to 7.7) (3 trials, n=717).
Nausea, photophobia and phonophobia were reduced more with paracetamol at 2 hours
(NNTs of 7 to 11). More individuals were free of any functional disability at 2 hours
with paracetamol (RR 0.87, 95% CI 0.81 to 0.94; NNT 10; 95% CI 6.0 to 22; 3 trials,
n=717). Fewer participants needed rescue medication over 6 hours (RR 0.59, 95% CI
0.47 to 0.74; NNT 6, 95% CI 4,1 to 10; 2 trials, n= 635).
- Paracetamol 1 000 mg plus metoclopramide 10 mg vs. oral sumatriptan 100 mg (2 trials,
n=1 140): There was no significant difference for 2-hour headache relief (RR 0.93,
95% CI 0.81 to 1.1). There were no 2-hour pain-free data. There was no significant
difference for relief of "light/noise sensitivity" at 2 hours (RR 0.87, 95% CI 0.77
to 0.98), but slightly more individuals needed rescue medication over 24 hours with
the combination therapy (RR 1.2, 95% CI 1.0 to 1.4; NNT 17, 95% CI 9.0 to 210).
Adverse event rates were similar between paracetamol and placebo, and between paracetamol
plus metoclopramide and sumatriptan. No serious adverse events occurred with paracetamol
alone, but more "major" adverse events occurred with sumatriptan than with the combination
therapy (NNH 32, 95% CI 18 to 112).
References
- Derry S, Moore RA. Paracetamol (acetaminophen) with or without an antiemetic for acute
migraine headaches in adults. Cochrane Database Syst Rev 2013;4():CD008040. «PMID: 23633349»PubMed
Article ID: evd06823
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