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.
After a pharmacist was added to Melbourne’s acute stroke response system in 2014, there was a significant improvement in time to thrombolysis, with median DTNT improved from 73 (to 61 minutes, according to a retrospective review of outcomes for 218 stroke patients (64 patients pre and 122 patients post implementation).
The improvements from having a pharmacist on the stroke team were attributed to factors such as enhanced pre-hospital interventions such as excluding active anticoagulation, provision of antihypertensive therapy, streamlined communication and ongoing auditing.
The findings are published in Journal of Clinical Pharmacy and Therapeutics.
Don’t use cannabis for chronic pain: expert groups
Expert groups representing pain specialists have recommended against medicinal cannabis for people with persistent non-cancer pain. Although cannabis products are now being made available by the TGA, there is a critical lack of evidence that cannabis provides a consistent benefit for any type of chronic non-cancer pain, according to the Faculty of Pain Medicine of the Australian and NZ College of Anaesthetists (ANZCA). In a Choosing Wisely recommendation the group says cannabidiol products formulations have not been shown in high quality randomised controlled trials to be effective for pain indications, while evidence of harms does exist, particularly in relation to sedative effects, interactions with other medications and neuropsychiatric effects.
“Given the above, the clinical use of cannabinoid products cannot be ethically recommended outside a properly established and registered clinical trial environment,” they state.