Comparative Efficacy of Magnesium Sulphate and Dexamethasone/Metoclopramide in the Treatment of Acute Migraine Headaches

Background: Migraine, a neurological condition characterized by intense and debilitating headaches, poses a significant public health issue affecting millions worldwide. The complexity of migraine pathophysiology often makes its management challenging. Despite various treatment modalities, the quest for the most effective and rapid relief from acute migraine episodes remains a pertinent concern in clinical practice. Objective: This study aimed to compare the efficacy of magnesium sulfate and a combination of dexamethasone/metoclopramide in treating acute migraine headaches to identify the most effective treatment option for rapid pain relief. Methods: This randomized controlled trial was conducted at the Department of Emergency Medicine, Benazir Bhutto Hospital, Rawalpindi, over six months from November 25, 2015, to May 24, 2016. A total of 70 patients were enrolled, with 35 patients assigned to Group A and 35 to Group B. Group A received 1g of magnesium sulfate in 100ml normal saline over 15 minutes, while Group B received 8mg of dexamethasone and 10mg of metoclopramide in a similar saline solution and infusion time. Pain severity was assessed using the Numeric Rating Scale (NRS) at baseline and two hours after medication administration. Data were analyzed using SPSS Version 25, with mean ± standard deviation calculated for age and NRS scores. Frequency and percentages were computed for gender and efficacy. Efficacy between the groups was compared using Chi-square tests, and stratification was applied to control for age and gender, followed by post-stratification Chi-square testing. A p-value of ≤ 0.05 was considered statistically significant. Results: The results showed a significant difference in pain relief between the two groups. In Group A, 23 patients (65.7%) reported significant pain relief compared to 13 patients (34.3%) in Group B (p=0.017). Stratification by age revealed that in patients under 30 years, 11 patients (31.4%) in Group A experienced pain relief compared to 8 patients (22.9%) in Group B (p=0.202). For patients over 30 years, 12 patients (34.3%) in Group A reported pain relief, compared to 5 patients (14.3%) in Group B (p=0.084). Gender stratification showed that among males, 5 (14.3%) in Group A experienced pain relief compared to 9 (25.7%) in Group B (p=0.408), while among females, 18 (51.4%) in Group A reported pain relief compared to 4 (11.4%) in Group B (p=0.000). Conclusion: Magnesium sulfate was found to be a more effective and faster-acting medication compared to a combination of dexamethasone and metoclopramide for the treatment of acute migraine headaches. This finding highlights the potential of magnesium sulfate as a preferred option for rapid pain relief in clinical settings, particularly for female patients.