Which Parenteral Treatment Is Best for Acute Migraine?

Treatment for acute migraine is a common reason for emergency department (ED) visits, where adequate therapy can prevent admission for symptom control. In this study, researchers randomized 330 patients presenting to a single ED with acute migraine to receive one of three parenteral therapies: valproate (1 g), metoclopramide (10 mg), or ketorolac (30 mg). Baseline pain severity on a verbal 0-to-10 scale was ≥7 in all enrolled patients. The primary outcome was improvement in pain severity 1 hour after treatment, with a between-group difference of 1.3 points representing a minimum clinically significant change. The authors performed an intention-to-treat analysis for each of the three pairwise comparisons.

Valproate recipients improved by 2.8 …