Browse > Article
http://dx.doi.org/10.3344/kjp.2017.30.3.176

Intravenous caffeine citrate vs. magnesium sulfate for reducing pain in patients with acute migraine headache; a prospective quasi-experimental study  

Baratloo, Alireza (Department of Emergency Medicine, Tehran University of Medical Sciences)
Mirbaha, Sahar (Department of Emergency Medicine, Shahid Beheshti University of Medical Sciences)
Kasmaei, Hossein Delavar (Department of Neurology, Shahid Beheshti University of Medical Sciences)
Payandemehr, Pooya (Department of Emergency Medicine, Tehran University of Medical Sciences)
Elmaraezy, Ahmed (Faculty of Medicine, Al Azhar University)
Negida, Ahmed (Medical Research Group of Egypt)
Publication Information
The Korean Journal of Pain / v.30, no.3, 2017 , pp. 176-182 More about this Journal
Abstract
Background: Current evidence suggests that intravenous magnesium sulfate might be effective for reducing migraine pain. In a recent pilot study, we showed that intravenous caffeine citrate could reduce the severity of migraine headache. The objective of this study is to investigate the efficacy of intravenous caffeine citrate vs. magnesium sulfate for management of acute migraine headache. Methods: We conducted a prospective quasi-experimental study from January until May 2016 in two educational medical centers of Shahid Beheshti University of Medical Sciences (Shoahadaye Tajrish Hospital and Imam Hossein Hospital), Tehran, Iran. The study included patients who were referred to the emergency department and met the migraine diagnosis criteria of the International Headache Society. Patients were allocated into 2 groups receiving either 60 mg intravenous caffeine or 2 g intravenous magnesium sulfate. The pain scores, based on the visual analog scale, were recorded on admission, as well as one and two hours after receiving the drug. A Chi-Square test and student t-test were used for analysis of baseline characteristics. A Mann-Whitney U test and Wilcoxon singed rank test were used to analyze differences in the visual analogue scale (VAS) score between and within the groups respectively. Results: In total, 70 patients (35 patients in each group) with the mean age of $33.1{\pm}11.3years$ were included (64.3% female). For the Caffeine citrate group, the median pain score decreased from 9.0 (2.0) to 5.0 (4.0) after one hour and to 3.0 (4.0) after two hours. For the magnesium sulfate group, the pain score decreased from 8.0 (2.0) to 2.0 (2.0) after one hour and to 0.0 (1.0) after two hours. Both intravenous caffeine citrate and intravenous magnesium sulfate reduced pain scores significantly but the magnesium sulfate group showed more improvement than the Caffeine citrate group after one hour (P < 0.001) and after two hours (P < 0.001). Conclusions: It is likely that both intravenous caffeine and intravenous magnesium sulfate can reduce the severity of migraine headache. Moreover, intravenous magnesium sulfate at a dose of 2 g might be superior to intravenous caffeine citrate 60 mg for the short term management of migraine headache in emergency departments.
Keywords
Caffeine citrate; Emergency department; Headache; Magnesium sulfate; Migraine disorders; Pain management;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Goldstein J, Silberstein SD, Saper JR, Ryan RE Jr, Lipton RB. Acetaminophen, aspirin, and caffeine in combination versus ibuprofen for acute migraine: results from a multicenter, double-blind, randomized, parallel-group, single-dose, placebo-controlled study. Headache 2006; 46: 444-53.   DOI
2 Silberstein SD, Winner PK, Chmiel JJ. Migraine preventive medication reduces resource utilization. Headache 2003; 43: 171-8.   DOI
3 Baratloo A, Bafarani SA, Forouzanfar MM, Hashemi B, Friedman BW, Abdalvand A. Intravenous caffeine versus intravenous ketorolac for the management of moderate to severe migraine headache. Bangladesh J Pharmacol 2016; 11: 428-32.   DOI
4 Baratloo A, Negida A, El-Ashal G, Behnaz N. Intravenous caffeine for the treatment of acute migraine: a pilot study. J Caffeine Res 2015; 5: 125-9.   DOI
5 Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken) 2011; 63 Suppl 11: S240-52.   DOI
6 Alschuler KN, Jensen MP, Ehde DM. Defining mild, moderate, and severe pain in persons with multiple sclerosis. Pain Med 2012; 13: 1358-65.   DOI
7 Zelman DC, Dukes E, Brandenburg N, Bostrom A, Gore M. Identification of cut-points for mild, moderate and severe pain due to diabetic peripheral neuropathy. Pain 2005; 115: 29-36.   DOI
8 Kelly AM. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J 2001; 18: 205-7.   DOI
9 Ray BS, Wolff HG. Experimental studies on headache: pain-sensitive structures of the head and their significance in headache. Arch Surg 1940; 41: 813-56.   DOI
10 Silberstein SD, Lipton RB, Dalessio DJ. Wolff's headache and other head pain. 7th ed. New York (NY), Oxford University Press. 2001, p 606.
11 Lance JW, Goadsby PJ. Chapter 8: migraine: pathophysiology. In: Mechanism and management of headache. 7th ed. Edited by Lance JW, Goadsby PJ. Oxford, Elsevier Butterworth-Heinemann. 2005, pp 87-121.
12 Silberstein SD, Lipton RB, Goadsby PJ. Headache in clinical practice. Oxford, Isis Medical Media. 1998, p 250.
13 Ashina S, Bendtsen L, Ashina M. Pathophysiology of migraine and tension-type headache. Tech Reg Anesth Pain Manag 2012; 16: 14-8.   DOI
14 Pietrobon D, Moskowitz MA. Pathophysiology of migraine. Annu Rev Physiol 2013; 75: 365-91.   DOI
15 Olesen J, Friberg L, Olsen TS, Iversen HK, Lassen NA, Andersen AR, et al. Timing and topography of cerebral blood flow, aura, and headache during migraine attacks. Ann Neurol 1990; 28: 791-8.   DOI
16 Taylor FR. Nutraceuticals and headache: the biological basis. Headache 2011; 51: 484-501.   DOI
17 Bolay H, Reuter U, Dunn AK, Huang Z, Boas DA, Moskowitz MA. Intrinsic brain activity triggers trigeminal meningeal afferents in a migraine model. Nat Med 2002; 8: 136-42.   DOI
18 Goadsby PJ, Lipton RB, Ferrari MD. Migraine--current understanding and treatment. N Engl J Med 2002; 346: 257-70.   DOI
19 Tepper SJ. Complementary and alternative treatments for childhood headaches. Curr Pain Headache Rep 2008; 12: 379-83.   DOI
20 Bhaskar S, Saeidi K, Borhani P, Amiri H. Recent progress in migraine pathophysiology: role of cortical spreading depression and magnetic resonance imaging. Eur J Neurosci 2013; 38: 3540-51.   DOI
21 Eikermann-Haerter K, Ayata C. Cortical spreading depression and migraine. Curr Neurol Neurosci Rep 2010; 10: 167-73.   DOI
22 D'Andrea G, Leon A. Pathogenesis of migraine: from neurotransmitters to neuromodulators and beyond. Neurol Sci 2010; 31 Suppl 1: S1-7.
23 Levy D. Migraine pain and nociceptor activation--where do we stand? Headache 2010; 50: 909-16.   DOI
24 Olesen J, Burstein R, Ashina M, Tfelt-Hansen P. Origin of pain in migraine: evidence for peripheral sensitisation. Lancet Neurol 2009; 8: 679-90.   DOI
25 Pietrobon D, Striessnig J. Neurobiology of migraine. Nat Rev Neurosci 2003; 4: 386-98.   DOI
26 Dunwiddie TV, Masino SA. The role and regulation of adenosine in the central nervous system. Annu Rev Neurosci 2001; 24: 31-55.   DOI
27 Bolay H, Ozge A, Saginc P, Orekici G, Uluduz D, Yalin O, et al. Gender influences headache characteristics with increasing age in migraine patients. Cephalalgia 2015; 35: 792-800.   DOI
28 Scher AI, Lipton RB, Stewart W. Risk factors for chronic daily headache. Curr Pain Headache Rep 2002; 6: 486-91.   DOI
29 Tavares C, Sakata RK. Caffeine in the treatment of pain. Rev Bras Anestesiol 2012; 62: 387-401.   DOI
30 Chiu HY, Yeh TH, Huang YC, Chen PY. Effects of intravenous and oral magnesium on reducing migraine: a meta-analysis of randomized controlled trials. Pain Physician 2016; 19: E97-112.
31 Vallerand AH, Polomano RC. The relationship of gender to pain. Pain Manag Nurs 2000; 1: 8-15.   DOI
32 El Tumi H, Johnson MI, Dantas PB, Maynard MJ, Tashani OA. Age-related changes in pain sensitivity in healthy humans: a systematic review with meta-analysis. Eur J Pain 2017; 21: 955-64.   DOI
33 Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL 3rd. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain 2009; 10: 447-85.
34 Fillingim RB. Sex, gender, and pain: women and men really are different. Curr Rev Pain 2000; 4: 24-30.   DOI
35 Yezierski RP. The effects of age on pain sensitivity: preclinical studies. Pain Med 2012; 13 Suppl 2: S27-36.   DOI
36 Victor TW, Hu X, Campbell JC, Buse DC, Lipton RB. Migraine prevalence by age and sex in the United States: a life-span study. Cephalalgia 2010; 30: 1065-72.   DOI
37 Prior MJ, Codispoti JR, Fu M. A randomized, placebocontrolled trial of acetaminophen for treatment of migraine headache. Headache 2010; 50: 819-33.   DOI
38 Harris AD, McGregor JC, Perencevich EN, Furuno JP, Zhu J, Peterson DE, et al. The use and interpretation of quasi-experimental studies in medical informatics. J Am Med Inform Assoc 2006; 13: 16-23.   DOI
39 Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia 2013; 33: 629-808.   DOI
40 Marmura MJ, Silberstein SD, Schwedt TJ. The acute treatment of migraine in adults: the american headache society evidence assessment of migraine pharmacotherapies. Headache 2015; 55: 3-20.   DOI
41 Lipton RB, Baggish JS, Stewart WF, Codispoti JR, Fu M. Efficacy and safety of acetaminophen in the treatment of migraine: results of a randomized, double-blind, placebocontrolled, population-based study. Arch Intern Med 2000; 160: 3486-92.   DOI
42 Becker WJ. Acute migraine treatment in adults. Headache 2015; 55: 778-93.   DOI
43 Suthisisang C, Poolsup N, Kittikulsuth W, Pudchakan P, Wiwatpanich P. Efficacy of low-dose ibuprofen in acute migraine treatment: systematic review and meta-analysis. Ann Pharmacother 2007; 41: 1782-91.   DOI
44 Boska MD, Welch KM, Barker PB, Nelson JA, Schultz L. Contrasts in cortical magnesium, phospholipid and energy metabolism between migraine syndromes. Neurology 2002; 58: 1227-33.   DOI
45 Mauskop A, Altura BT, Altura BM. Serum ionized magnesium levels and serum ionized calcium/ionized magnesium ratios in women with menstrual migraine. Headache 2002; 42: 242-8.   DOI
46 Corbo J, Esses D, Bijur PE, Iannaccone R, Gallagher EJ. Randomized clinical trial of intravenous magnesium sulfate as an adjunctive medication for emergency department treatment of migraine headache. Ann Emerg Med 2001; 38: 621-7.   DOI
47 Trauninger A, Pfund Z, Koszegi T, Czopf J. Oral magnesium load test in patients with migraine. Headache 2002; 42: 114-9.   DOI
48 Cete Y, Dora B, Ertan C, Ozdemir C, Oktay C. A randomized prospective placebo-controlled study of intravenous magnesium sulphate vs. metoclopramide in the management of acute migraine attacks in the emergency department. Cephalalgia 2005; 25: 199-204.   DOI
49 Demirkaya S, Vural O, Dora B, Topcuoglu MA. Efficacy of intravenous magnesium sulfate in the treatment of acute migraine attacks. Headache 2001; 41: 171-7.   DOI
50 Bigal ME, Bordini CA, Tepper SJ, Speciali JG. Intravenous magnesium sulphate in the acute treatment of migraine without aura and migraine with aura. A randomized, double-blind, placebo-controlled study. Cephalalgia 2002; 22: 345-53.   DOI
51 Koseoglu E, Talaslioglu A, Gonul AS, Kula M. The effects of magnesium prophylaxis in migraine without aura. Magnes Res 2008; 21: 101-8.
52 Teigen L, Boes CJ. An evidence-based review of oral magnesium supplementation in the preventive treatment of migraine. Cephalalgia 2015; 35: 912-22.   DOI
53 Baratloo A, Rouhipour A, Forouzanfar MM, Safari S, Amiri M, Negida A. The role of caffeine in pain management: a brief literature review. Anesth Pain Med 2016; 6: e33193.
54 Diener HC, Pfaffenrath V, Pageler L, Peil H, Aicher B. The fixed combination of acetylsalicylic acid, paracetamol and caffeine is more effective than single substances and dual combination for the treatment of headache: a multicentre, randomized, double-blind, single-dose, placebo-controlled parallel group study. Cephalalgia 2005; 25: 776-87.   DOI