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Original Research

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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:


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.


Emergency department; Migraine; Paracetamol; Zolmitriptan

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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.


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