Systematic review: Is Metoclopramide more effective than Sumatriptan in relieving pain from migraine in adults in the Emergency Department (ED) setting?

Migraine headache is a common disorder; patients attending Emergency Departments (ED) for migraine symptoms internationally account for 1-3% of total ED annual attendances. A systematic review was undertaken of reports comparing the effectiveness of metoclopramide intravenously (IV) with that of sumatriptan subcutaneously (SC), in an ED setting, for the immediate relief of migraine and their measurable effects in relieving pain intensity. Findings of two identified comparable reports confirm the individual efficacy of the study drugs in pain relief. However, whilst one report concludes that there is no statistical or significant clinical advantage for one drug over the other, the other report suggests that metoclopramide has a distinct advantage. One study is well structured methodologically, but the other has significant risk of bias. The analysis of the chosen studies demonstrates the need for rigorous study design and robust reporting requirements to obviate this risk. Further studies are required to explore comparable effect. Implications for clinical practice from the report outcomes indicate the individual effectiveness of both study drugs in providing pain relief for migraine in the Emergency setting, but not the comparable efficacy of one drug over the other.