Doubling down on post-traumatic headache
A combination of two anti-nausea drugs, metoclopramide and diphenhydramine may be effective for relieving acute post-traumatic headache, a US study shows.
Published in Neurology, the prospective trial compared outcomes in 81 patients who experienced headache within 10 days of acute trauma, randomised to 20mg metoclopramide and 25 mg of diphenhydramine intravenously, versus 79 patients randomised to placebo.
Patients treated with metoclopramide and diphenhydramine reported relief of headache within an hour, with a 5.2 (SD 2.3) improvement in headache scores compared to 3.8 (SD 2.6) for placebo patients – a difference favouring metoclopramide of 1.4 (95% CI 0.7, 2.2, p<0.01).
Adverse events such as drowsiness, restlessness or diarrhoea were reported by 43% of patients who received metoclopramide and 28% of patients who received placebo (p=0.04).
“More research is needed to determine the most effective dose of metoclopramide, and how long to administer it, to see if people can get longer-term relief after they leave the emergency room,” said the study investigators.
Stroke response outcomes better with pharmacist on team
Stroke callout teams can improve door to needle times (DTNT)for thrombolysis with alteplase by including an emergency medicine pharmacist in the team, Victorian experience shows.