Current emergency treatment of severe migraine headaches

Headache. 1993 Nov-Dec;33(10):560-2. doi: 10.1111/j.1526-4610.1993.hed3310560.x.


Objective: To compare the efficacy of the combination of meperidine and hydroxyzine IM, versus dihydroergotamine and metoclopramide IV in the treatment of severe migraine headaches.

Design: This was a randomized double-blind, double-dummy study.

Setting: Established patients, whose headache had failed to respond to their usual abortive agent, were invited to an out-patient headache clinic for the study.

Patients: Twenty-eight patients, diagnosed as suffering from either migraine headache or chronic daily headache, were screened on arrival to exclude life-threatening causes.

Intervention: Group A (14 patients) received dihydroergotamine 1mg and metoclopramide 10mg IV and a placebo injection IM, and Group B (14 patients) received meperidine 75mg and hydroxyzine 75mg IM and a placebo injection IV.

Main outcome measures: Patients rated their headaches on a scale of 0-3 prior to treatment and again at 30 and 60 minutes.

Results: Both groups experienced improvement in headache severity. (Group A P = 0.001 and Group B P = 0.003). Improvement in pain scale score was greater for Group A than Group B. (P = 0.006). The number of patients having a mild or no headache in Group A (13/14) was significantly greater than Group B (3/14). (P < 0.001)

Conclusions: The combination of dihydroergotamine and metoclopramide IV should replace the standard IM narcotic and anti-emetic as the parenteral treatment of choice for severe migraine headache.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Dihydroergotamine / administration & dosage
  • Dihydroergotamine / therapeutic use
  • Double-Blind Method
  • Drug Therapy, Combination
  • Emergencies
  • Humans
  • Hydroxyzine / administration & dosage
  • Hydroxyzine / therapeutic use
  • Injections, Intramuscular
  • Injections, Intravenous
  • Meperidine / administration & dosage
  • Meperidine / therapeutic use
  • Metoclopramide / administration & dosage
  • Metoclopramide / therapeutic use
  • Migraine Disorders / drug therapy*
  • Pain Measurement


  • Hydroxyzine
  • Dihydroergotamine
  • Meperidine
  • Metoclopramide