Randomized trial of IV valproate vs metoclopramide vs ketorolac for acute migraine

Abstract

Friedman et al.1 reported the findings from a randomized trial comparing single-dose IV metoclopramide, valproate, and ketorolac in acute migraine. We have some concerns. The study showed that metoclopramide was more efficacious. However, if adopted as a routine antimigraine treatment in emergency departments it may lead to widespread, repeated use of metoclopramide with potentially serious consequences. Metoclopramide is a major cause of tardive dyskinesia (TD).2 Whereas most cases of TD occur after chronic use, we and others have observed that …