RESUMO
STUDY OBJECTIVE: To evaluate intramuscular dihydroergotamine in direct comparison with opioid analgesia in the treatment of acute migraine headache. METHODS: This was a prospective, multicenter, double-blind trial performed in the emergency departments of 11 general hospitals in the United States. One hundred seventy-one patients between the ages of 18 and 60 years who presented to the ED with acute migraine headache were enrolled. Patients were randomly assigned to receive either 1 mg dihydroergotamine (DHE) or 1.5 mg/kg meperidine (MEP) by intramuscular injection. The anti-nauseant hydroxyzine (H) was coadministered in both treatment groups. RESULTS: One hundred fifty-six patients were evaluable. Treatment groups were comparable in sample size, demographics, and baseline measurements of headache pain. Reduction of headache pain as measured on a 100-mm visual analog scale was 41+/-33 mm (53.5% reduction) for the DHE group, and 45+/-30 mm (55.7% reduction) for the MEP group at 60 minutes after treatment (difference=2.2%; 95% confidence interval [CI] -10%, 14.5%; P=.81). Reduction in the severity of nausea and improvement in functional ability were similar between treatment groups. Central nervous system adverse events were less common in the DHE group (DHE 23.5% versus MEP 37.6%, difference-14.1%: 95% CI -28%, 0%). In particular, dizziness was reported less commonly with DHE than MEP (2% versus 15%, difference=-13%: 95% CI -21%, -5%). CONCLUSION: In this prospective, double-blind trial of a convenience sample of ED patients randomly assigned to one of two treatment regimens, DHE and MEP were comparable therapies for acute migraine. The use of DHE avoids several problems associated with opioid analgesia, including dizziness.
Assuntos
Analgésicos não Narcóticos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Antieméticos/uso terapêutico , Di-Hidroergotamina/uso terapêutico , Hidroxizina/uso terapêutico , Meperidina/uso terapêutico , Transtornos de Enxaqueca/tratamento farmacológico , Doença Aguda , Adolescente , Adulto , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/efeitos adversos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Antieméticos/administração & dosagem , Antieméticos/efeitos adversos , Di-Hidroergotamina/administração & dosagem , Di-Hidroergotamina/efeitos adversos , Método Duplo-Cego , Combinação de Medicamentos , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Hidroxizina/administração & dosagem , Hidroxizina/efeitos adversos , Injeções Intramusculares , Masculino , Meperidina/administração & dosagem , Meperidina/efeitos adversos , Pessoa de Meia-Idade , Náusea/tratamento farmacológico , Medição da Dor , Estudos Prospectivos , Fatores de TempoRESUMO
Aortic dissection usually presents with chest pain, abnormal pulses, and a widened mediastinum on chest radiograph. It is rarely associated with the superior vena cava syndrome (SVCS), which more commonly occurs in the setting of malignant disease. A patient who had SVCS as a result of a painless aortic dissection is presented and compared with other previously reported cases of simultaneous SVCS and aortic dissection.
