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The following is a summary of “Examining the Effect of Intramuscular vs Intravenous Metoclopramide for Treatment of Acute Headaches to Expedite Throughput in the Emergency Department,” published in the January 2025 issue of Emergency Medicine by Barbera et al. 

Various prophylactic and abortive therapies, including off-label use of metoclopramide, have demonstrated efficacy and medical consensus in managing acute migraine symptoms despite being non-specific to migraines.  

Researchers conducted a retrospective study to compare the impact of intramuscular (IM) vs intravenous (IV) metoclopramide on emergency department (ED) length of stay (LOS) and pain relief in individuals with presumed migraine headaches, including efficacy in addressing subjective pain.  

They analyzed data from adult ED visits between January 2020 and September 2022, focusing on individuals with a primary diagnosis of acute migraine or non-specific headache who received IM or IV metoclopramide. Propensity score matching was used to balance covariates between the IM and IV groups and account for confounding factors, including adjuvant therapies.  

The results showed a reduced LOS with IM metoclopramide compared to IV metoclopramide, both before and after propensity score matching. Before matching, the median LOS for IM was 67 minutes (interquartile range [IQR: 42.50, 99.50]) vs 168 minutes for IV (IQR [137, 234]) (median difference = 102, 95% CI: 93, 112, r = 0.44, P < 0.001). After matching, IM administration had a median LOS of 73 minutes (IQR [47, 103]) compared to 166 minutes for IV (IQR [129, 259]) (median difference = 97, 95% CI [81, 144], r = 0.68, P < 0.001). A 95% CI was applied to all outcomes, with no significant difference observed in pain reduction between groups.  

Investigators concluded the IM administration of metoclopramide for acute headache treatment in the ED resulted in a shorter median LOS compared to IV administration while maintaining similar clinical efficacy. 

Source: jem-journal.com/article/S0736-4679(25)00021-6/abstract