Article Data

  • Views 749
  • Dowloads 178

Original Research

Open Access Special Issue

Oral paracetamol versus zolmitriptan to treat acute migraine attack in the emergency department

  • Cuneyt Arikan1
  • Atakan Yilmaz2
  • Mert Ozen2
  • Murat Seyit2
  • Ibrahim Turkcuer2
  • Ezgi Demirozogul3

1Izmir Ataturk Education and Research Hospital, Katip Çelebi University, Department of Emergency Medicine, Izmir, Turkey

2Pamukkale University, Medical Faculty, Department of Emergency Medicine, 20070, Denizli, Turkey

3Gaziantep 25 Aralik State Hospital, Emergency Service, Gaziantep, Turkey

DOI: 10.22514/sv.2021.040 Vol.17,Issue 5,September 2021 pp.110-116

Submitted: 19 January 2021 Accepted: 09 February 2021

Published: 08 September 2021

*Corresponding Author(s): Cuneyt Arikan E-mail: carikan0115@gmail.com

Abstract

Background: Treatment provided in an emergency department is aimed at alleviating pain immediately with minimized adverse effects as well as warding off further migraine attacks. The primary aim of this article is to compare the effectiveness of oral paracetamol versus zolmitriptan in treating acute migraine attacks.

Methods: This prospective, randomized, and controlled study was carried out at a tertiary care hospital visited by 95,000 patients annually. The study recruited 200 participants who were randomized into two groups. One group received 1000 mg paracetamol while the other group received 2.5 mg zolmitriptan orally. Baseline pain scores were recorded using the Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) at 15, 30 and at 60 min following administration of the study drugs. Patients requiring further treatment were provided fentanyl at a dosage of 1 µg/kg as a rescue therapy.

Results: A significant decrease was evident in VAS and NRS scores following the administration of the study drugs in both groups (P < 0.001). The change in VAS pain scores after 15, 30 and 60 min was calculated as 17.0 ± 13.9, 41.2 ± 16.3 and 61.2 ± 17.5 mm, respectively, in the paracetamol group and 14.2 ± 11.7, 39.2 ± 17.9 and 59.2± 19.3 mm, respectively, in the zolmitriptan group, which did not indicate significant differences (P = 0.103, P = 0.425, P = 0.483, respectively). Likewise, NRS pain scores showed a downward trend in line with VAS pain scores and did not yield a significant difference (P = 0.422). No significant difference concerning rescue therapy was noted between the two groups (P = 0.596).

Conclusion: Oral paracetamol and zolmitriptan prove to be similarly effective and have low incidence of acute side effects in treating acute migraine cases without aura.


Keywords

Emergency department; Migraine; Paracetamol; Zolmitriptan


Cite and Share

Cuneyt Arikan,Atakan Yilmaz,Mert Ozen,Murat Seyit,Ibrahim Turkcuer,Ezgi Demirozogul. Oral paracetamol versus zolmitriptan to treat acute migraine attack in the emergency department. Signa Vitae. 2021. 17(5);110-116.

References

[1] Burch R, Rizzoli P, Loder E. The prevalence and ımpact of migraine and severe headache in the United States: figures and trends from government health studies. Headache. 2018; 58: 496-505.

[2] Pitts SR, Niska RW, Xu J, Burt CW. National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary. National Health Statistics Reports. 2008; 7: 1-38.

[3] Negro A, Spuntarelli V, Sciattella P, Martelletti P. Rapid referral for headache management from emergency department to headache centre: four years data. The Journal of Headache and Pain. 2020; 21: 25.

[4] Lipton RB, Bigal ME. Migraine: epidemiology, ımpact, and risk factors for progression. Headache. 2005; 45: S3-S13.

[5] Tintinalli JE, Cline DM, Ma OJ, Cydulka RK, Meckler GD, Thomas SH (eds). Tintinalli’s emergency medicine: a comprehensive study guide (pp. 1116-1117). 7th ed. New York: McGraw-Hill Education. 2010.

[6] Bartleson JD, Cutrer FM. Migraine update. Diagnosis and treatment. Minnesota Medicine. 2010; 93: 36-41.

[7] Turkcuer I, Serinken M, Eken C, Yilmaz A, Akdag Ö, Uyanık E, et al. Intravenous paracetamol versus dexketoprofen in acute migraine attack in the emergency department: a randomised clinical trial. Emergency Medicine Journal. 2014; 31: 182-185.

[8] Forrest JAH, Clements JA, Prescott LF. Clinical pharmacokinetics of paracetamol. Clinical Pharmacokinetics. 1982; 7: 93-107.

[9] Kayaalp O. Rasyonel Tedavi Yönünden Tıbbi Farmakoloji (pp.973-975). 10th ed. Hacettepe-Taş Yayınları. 2002.

[10] Marmura MJ, Silberstein SD, Schwedt TJ. The acute treatment of migraine in adults: the American headache society evidence assessment of migraine pharmacotherapies. Headache. 2015; 55: 3-20.

[11] Ferrari MD. 311C90: increasing the options for therapy with effective acute antimigraine 5HT1B/1D receptor agonists. Neurology. 1997; 48: S21-S24.

[12] Lacey LF, Hussey EK, Fowler PA. Single dose pharmacokinetics of sumatriptan in healthy volunteers. European Journal of Clinical Pharmacology. 1995; 47: 543-548.

[13] Seaber E, On N, Phıllıps S, Churchus R, Posner J, Rolan P. The tolerabil-ity and pharmacokinetics of the novel antimigraine compound 311C90 in healthy male volunteers. British Journal of Clinical Pharmacology. 1996; 41: 141-147.

[14] Dixon R, Warrander A. The clinical pharmacokinetics of zolmitriptan. Cephalalgia. 1997; 17: 15-20.

[15] Kalanuria AA, Peterlin BL. A review of the pharmacokinetics, pharma-codynamics and efficacy of zolmitriptan in the acute abortive treatment of migraine. Clinical Medicine. Therapeutics. 2009; 1: CMT.S2056.

[16] Rapoport AM, Ramadan NM, Adelman JU, Mathew NT, Elkind AH, Kudrow DB, et al. Optimizing the dose of zolmitriptan (Zomig, 311C90) for the acute treatment of migraine. a multicenter, double-blind, placebo-controlled, dose range-finding study. The 017 Clinical Trial Study Group. Neurology. 1997; 49: 1210-1218.

[17] The international classification of headache disorders. Headache classifi-cation subcommittee of the International Headache Society (pp. 24-25). 2nd ed. Cephalalgia. 2004.

[18] Smitherman TA, Burch R, Sheikh H, Loder E. The prevalence, impact, and treatment of migraine and severe headaches in the United States: a review of statistics from national surveillance studies. Headache. 2013; 53: 427-436.

[19] Cameron C, Kelly S, Hsieh S, Murphy M, Chen L, Kotb A, et al. Triptans in the acute treatment of migraine: a systematic review and network meta-analysis. Headache. 2015; 55: 221-235.

[20] Prior MJ, Codispoti JR, Fu M. A randomized, placebo-controlled trial of acetaminophen for treatment of migraine headache. Headache. 2010; 50: 819- 833.

[21] Tabeeva GR, Evdokimova EM, Shagbazyan AE. The efficacy of the second generation triptan migrepam in the treatment of migraine attacks: results of the comparative study. Zhurnal Nevrologii i Psikhiatrii Im. S.S. Korsakova. 2019; 119: 20-28. (In Russian)

[22] Bird S, Derry S, Moore RA. Zolmitriptan for acute migraine attacks in adults. The Cochrane Database of Systematic Reviews. 2014; 2014: CD008616.

[23] Evers S, Savi L, Omboni S, Lisotto C, Zanchin G, Pinessi L. Efficacy of frovatriptan as compared to other triptans in migraine with aura. The Journal of Headache and Pain. 2015; 16: 514.

[24] Thorlund K, Toor K, Wu P, Chan K, Druyts E, Ramos E, et al. Comparative tolerability of treatments for acute migraine: a network meta-analysis. Cephalalgia. 2017; 37: 965-978.

[25] Xu H, Han W, Wang J, Li M. Network meta-analysis of migraine disorder treatment by NSAIDs and triptans. The Journal of Headache and Pain. 2016; 17: 113.

[26] Becker WJ. Acute migraine treatment. Continuum. 2015; 21: 953-972.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 0.5(2019) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top