Nausea drugs alleviate post-concussion headache pain

Article written by Bruce Sylvester.

Treatment with two anti-nausea medications appears to alleviate headaches which took patients to the emergency room in the weeks after the initial injury. Researchers reported this finding on March 24, 2021 in Neurology.

“The headaches you get after a trauma like a fall, an assault or car accident can linger for months or even years and lead to a reduced quality of life, so the results of our study are promising,” said investigator Benjamin W. Friedman, M.D., professor of emergency medicine at Albert Einstein College of Medicine, Bronx, N.Y. 

The purpose of the study was to see whether treatment with intravenous metoclopramide plus diphenhydramine (20 mg of metoclopramide and 25 mg of diphenhydramine intravenously) was more effective than IV placebo for acute moderate or severe post-traumatic headache presented in the emergency room.

The investigators enrolled and randomized 160 subjects to the study, 81 to the combination therapy and 79 to placebo. The two cohorts had comparable baseline characteristics. All 160 subjects provided outcome data.

Eligible subjects had presented with for acute moderate or severe post-traumatic headache at the emergency room within 10 days of a head trauma.  

The primary outcome was improvement in pain on a 0-10 scale between baseline and one hour post treatment.

At one hour post-treatment, the combination treatment reduced average headache pain level by 5.2 points on the pain scale compared to 3.8 points for placebo. The difference was statistically significant (p<0.01)

In the combination therapy treated group, 43% experienced side effects such as drowsiness, restlessness or diarrhea, while 28% in the placebo treated group reported similar side effects.

The authors concluded, “Metoclopramide + diphenhydramine was more efficacious than placebo with regard to relief of post-traumatic headache in the ED [emergency department].”