IV Fluid Not Superior to Normal Saline for Migraine Headache Pain – Neurology Advisor

By | January 9, 2019

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Investigators analyzed the effectiveness of IV fluid therapy in patients admitted to the emergency department with migraine.
Investigators analyzed the effectiveness of IV fluid therapy in patients admitted to the emergency department with migraine.

Intravenous (IV) saline fluid administration did not confer a greater treatment effect than normal saline solution infusion for managing migraine headache pain, according to results of a pilot study published in the Annals of Emergency Medicine.

Patients age ≥18 who were admitted to an emergency department (ED) for migraine headache pain were randomly assigned to either receive 1 L of 1-hour IV-administered 0.9% normal saline solution (n=25) or a 1-hour 0.9% normal saline solution at 10 mL/hour as controls (n=24). At the start of fluid treatment, patients received IV diphenhydramine and prochlorperazine.

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Pain scores were assessed at baseline and at 60 minutes (end of treatment), 120 minutes, and 48 hours after treatment. The 10-point verbal pain rating scale was used to assess differences in self-reported pain between baseline and end of treatment. In addition, the researchers evaluated the rate of treatment completion, need for rescued medications, length of ED stay, and effectiveness of blinding.

Although both study groups demonstrated meaningful improvements in pain by 60 minutes, there was no difference in score improvement between the IV fluid group (4.5; 95% CI, 3.7-5.3) and the control group (4.9; 95% CI, 3.5-6.2). At the 120-minute mark, similar improvements in mean pain scores were also observed in the IV fluid (5.9; 95% CI, 4.8-7.1) and control groups (5.5; 95% CI, 4.1-6.8). Mean pain scores at 48 hours were 2.6 and 1.9 in the IV fluid and control groups, respectively. No difference was observed between the two groups with regard to ED length of stay.

Limitations of the study included its small-scale pilot design and the recruitment of patients from only one center.

Although no between-group outcome differences were observed during this study, the researchers suggested that “the small sample size means that we have not ruled out either a clinically important treatment benefit or harm from intravenous fluids.”

Reference

Jones CW, Remboski LB, Freeze B, et al. Intravenous fluid for the treatment of emergency department patients with migraine headache: a randomized controlled trial [published online October 26, 2018]. Ann Emerg Med. doi:10.1016/j.annemergmed.2018.09.004

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