Intravenous dipyrone for the acute treatment of episodic tension-type headache. A randomized, placebo-controlled, double-blind study

Acute headaches are responsible for a significant percentage of the case load at primary care units and emergency rooms in Brazil. Dipyrone (metamizol) is easily available in these settings, being the most frequently used drug. We conducted a randomized, placebo-controlled, double-blind study to assess the effect of dipyrone in the acute treatment of episodic tension-type headache. Sixty patients were randomized to receive placebo (intravenous injection of 10 ml saline) or 1 g dipyrone in 10 ml saline. We used seven parameters of analgesic evaluation. The patients receiving dipyrone showed a statistically significant improvement (P<0.05) of pain compared to placebo up to 30 min after drug administration. The therapeutic gain was 30 percent in 30 min and 40 percent in 60 min. The number of patients needed to be treated for at least one to have benefit was 3.3 in 30 min and 2.2 in 60 min. There were statistically significant reductions in the recurrence (dipyrone = 25 percent, placebo = 50 percent) and use of rescue medication (dipyrone = 20 percent, placebo = 47.6 percent) for the dipyrone group. Intravenous dipyrone is an effective drug for the relief of pain in tension-type headache and its use is justified in the emergency room setting

Alteration of the motor response to an acute painful stimulus during tonic immobility

The motor responses caused by liminal (1.0 and 3.0 mA, applied for 3 s) and subliminal electrical stimuli (40 below the liminal value) applied to the dental pulp of the upper incisors of adult guinea pigs (N = 41) are more intense during tonic immobility (TI) than in control situations. Tonic immobility is a temporary state of profound motor inhibition elicited by some form of physical restraint in our experiment induced by maneuvers of lateral postural inversion and movement restraint. This suggests the occurrence of hyperalgesia in the trigeminal territory in situations of direct confrontation with a predator, as in the case for tonic immobility. This hyperalgesia may protect in a reflex manner vital regions of the head and neck from fatal bites inflicted by the predator, but without interrupting the state of immobility, since in our experiments the electric stimuli had no disruptive effect on TI episodes.