Efficacy of intravenous propacetamol hydrochloride in the treatment of an acute attack of migraine

Background: Triptans are a family of selective serotonin (5-HT1B/1D) receptor agonists that are widely used to treat acute migraine attacks. Their efficacy is limited by side effects and the gastrointestinal manifestations of migraine. Aim: To compare the efficacy of a single intravenous administration of propacetamol, a prodrug of paracetamol (acetaminophen) with a single dose of oral rizatriptan in treating acute migraine attacks. Methods: Patients were selected from those who presented to the emergency room with a diagnosed migraine attack and who had not previously taken any analgesics. They were randomized into 2 groups: treatment with a single 1 g IV dose of propacetamol or with a single oral dose of 5 mg rizatriptan. Their Visual Analogue Scale (VAS) pain scores were assessed before and at 30, 60, and 120 min after treatment. Results: The patients who received the propacetamol had significantly improved VAS scores at 60 min compared to the rizatriptan group. There were no significant differences in VAS scores at 30 or 120 min post-treatment. Conclusion: Propacetamol is either equivalent or superior in efficacy to rizatriptan for treating acute migraine attacks, while having the advantage of parenteral administration in patients whose migraines are accompanied by nausea and vomiting. (C) 2014 Published by Elsevier B. V. on behalf of European Federation of Internal Medicine.