Intravenous paracetamol versus dexketoprofen in acute migraine attack in the emergency department: a randomised clinical trial

Objective Migraine is a common form of headache that is a major burden for patients who often seek emergency care. The goal of this study was to compare the effectiveness of intravenous non-steroidal antiinflammatory medication (dexketoprofen) with paracetamol (acetaminophen) in the treatment of an acute migraine attack. Materials and methods This prospective, randomised, double blind, controlled study was conducted in a tertiary care emergency unit. Study patients were randomised into two groups to receive either 50 mg of dexketoprofen trometamol or 1000 mg of paracetamol intravenously by rapid infusion in 150 mL of normal saline. Pain reduction was measured at baseline, and after 15 and 30 min, using a Visual Analogue Scale (VAS)) as the primary outcome. VAS is a measurement tool ranging from 0 (no pain) to 100 mm (worst pain). Results 200 patients were included in the final analysis. Mean (SD) age of the study subjects was 30.1 +/- 11 years and 81% (n=162) were women. Median reduction in VAS score at 30 min was 56 (IQR 30-78.5) for the paracetamol group and 55 (IQR 34-75) for the dexketoprofen group, with a difference of 1 mm (95% CI -7 to 10) between the two groups. Conclusions Intravenous paracetamol and dexketoprofen appear to produce equivalent pain relief for migraine in the emergency department. ClinicalTrials.gov No NCT01730326.