Comparison of granisetron and metoclopramide in the treatment of pain and emesis in migraine patients: A randomized controlled trial study

Hassan Amiri; Niloufar Ghodrati; Mehrnaz Nikuyeh; Samad Shams-Vahdati; Mehran Jalilzadeh-Binazar

doi:10.1016/j.tjem.2016.12.004

Hassan Amiri¹, Niloufar Ghodrati², Mehrnaz Nikuyeh¹, Samad Shams-Vahdati³, Mehran Jalilzadeh-Binazar⁴

¹Department of Emergency Medicine, Iran University of Medical Sciences, Tehran, Iran
²Department of Hematology and Oncology, Alborz University of Medical Sciences, Karaj, Iran
³Road Traffic Injury Research Center, Department of Emergency Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
⁴Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

Keywords: Migraine; Headache; Granisetron; Metoclopramide; Pain

Abstract

Objectives: One of the irritating features of migraine is emesis that can compromise taking oral medications. We designed this study to compare the effectiveness of granisetron and metoclopramide in reducing pain and treating emesis in migraine patients.

Methods: We included a total of 148 patients with migraine headache presenting to two referral hospitals in a prospective, double-blinded randomized controlled trial. We compared the effect of granisetron (2 mg intravenous) with metoclopramide (10 mg intravenous). Pain intensity and emesis episodes were recorded before drug administration, one, two and four 4 h after drug administration.

Results: Of the 148 patients, 47 were male and 101 were female. 75 patients received granisetron and 73 metoclopramide. Mean pain intensity before the administration of the medications was 7.67 ± 1.30 in granisetron group and 7.68 ± 1.13 in metoclopramide group with an insignificant difference. Mean pain intensity at one, two, and 4 h after drug administration was 3.20 ± 1.37, 2.39 ± 1.28, and 1.31 ± 0.52 in granisetron group and 5.04 ± 1.77, 4.1 ± 1.8, and 1.56 ± 0.68 in metoclopramide group (P = 0.03). Mean emesis episodes before drug administration were 1.85 ± 0.81 and 1.80 ± 0.77 in granisetron and metoclopramide groups, respectively. These episodes were 1.33 ± 0.66, 0.25 ± 0.49, and 0.04 ± 0.19 in granisetron group and 1.38 ± 0.73, 0.21 ± 0.47, and 0.41 ± 0.19 in metoclopramide group at one, two, and 4 h after the drug administration (P = 0.7).

Conclusion: To came in conclusion, compared to metoclopramide, granisetron is a better choice in acute migraine ATTACK because it decreases the patients' pain as well as their emesis.