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Review article
peer-reviewed

Metoclopramide for Acute Migraine Treatment in the Emergency Department: An Effective Alternative to Opioids



Abstract

In light of recent warnings by the United States (US) Surgeon General and Centers for Disease Control (CDC) guidelines for recommending more prudent use of opioid narcotics, the search for a non-opioid alternative for aborting acute migraines is particularly relevant. The CDC also estimates the prevalence of opioid dependence may be as high as 26% among patients prescribed opioids for chronic pain, not due to cancer, in the primary care setting. Given such staggering data, it is imperative that we, as caretakers, not foster opioid dependence but rather continue to investigate non-opioid therapies for the management of acute migraines in the emergent care settings. Our literature review demonstrates that metoclopramide should be used more frequently as first-line therapy for an acute migraine over opioids. The use of opioids specifically has been discouraged as migraine treatment by the American Headache Society citing “insufficient evidence” as the main reason. Metoclopramide, specifically using the 10 mg dose, has been cited as “highly likely to be effective” by the same guidelines. Another major issue with opioids is the growing potential for abuse, thus minimizing the use of these drugs for only special circumstances would be beneficial overall.



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Review article
peer-reviewed

Metoclopramide for Acute Migraine Treatment in the Emergency Department: An Effective Alternative to Opioids


Author Information

Mejdi Najjar Corresponding Author

College of Medicine, University of Central Florida College of Medicine

Tyler Hall

College of Medicine, University of Central Florida College of Medicine

Blanca Estupinan

College of Medicine, University of Central Florida College of Medicine


Ethics Statement and Conflict of Interest Disclosures

Conflicts of interest: The authors have declared that no conflicts of interest exist.


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Review article
peer-reviewed

Metoclopramide for Acute Migraine Treatment in the Emergency Department: An Effective Alternative to Opioids

  • Author Information
    Mejdi Najjar Corresponding Author

    College of Medicine, University of Central Florida College of Medicine

    Tyler Hall

    College of Medicine, University of Central Florida College of Medicine

    Blanca Estupinan

    College of Medicine, University of Central Florida College of Medicine


    Ethics Statement and Conflict of Interest Disclosures

    Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: April 20, 2017

    DOI

    10.7759/cureus.1181

    Cite this article as:

    Najjar M, Hall T, Estupinan B (April 20, 2017) Metoclopramide for Acute Migraine Treatment in the Emergency Department: An Effective Alternative to Opioids. Cureus 9(4): e1181. doi:10.7759/cureus.1181

    Publication history

    Received by Cureus: October 31, 2016
    Peer review began: December 28, 2016
    Peer review concluded: April 09, 2017
    Published: April 20, 2017

    Copyright

    © Copyright 2017
    Najjar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

In light of recent warnings by the United States (US) Surgeon General and Centers for Disease Control (CDC) guidelines for recommending more prudent use of opioid narcotics, the search for a non-opioid alternative for aborting acute migraines is particularly relevant. The CDC also estimates the prevalence of opioid dependence may be as high as 26% among patients prescribed opioids for chronic pain, not due to cancer, in the primary care setting. Given such staggering data, it is imperative that we, as caretakers, not foster opioid dependence but rather continue to investigate non-opioid therapies for the management of acute migraines in the emergent care settings. Our literature review demonstrates that metoclopramide should be used more frequently as first-line therapy for an acute migraine over opioids. The use of opioids specifically has been discouraged as migraine treatment by the American Headache Society citing “insufficient evidence” as the main reason. Metoclopramide, specifically using the 10 mg dose, has been cited as “highly likely to be effective” by the same guidelines. Another major issue with opioids is the growing potential for abuse, thus minimizing the use of these drugs for only special circumstances would be beneficial overall.



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Create a free account to continue reading this article.

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Mejdi Najjar

College of Medicine, University of Central Florida College of Medicine

For correspondence:
mnajjar@knights.ucf.edu

Tyler Hall

College of Medicine, University of Central Florida College of Medicine

Blanca Estupinan

College of Medicine, University of Central Florida College of Medicine

Mejdi Najjar

College of Medicine, University of Central Florida College of Medicine

For correspondence:
mnajjar@knights.ucf.edu

Tyler Hall

College of Medicine, University of Central Florida College of Medicine

Blanca Estupinan

College of Medicine, University of Central Florida College of Medicine