Intravenous Magnesium Sulfate for Acute Nontraumatic Headache in the Emergency Department
Abstract
Study objective: The aim of this study was to determine whether intravenous MgSO4 offers additional analgesic benefit when administered simultaneously with paracetamol in emergency department patients presenting with acute nontraumatic headache.
Methods: In this randomized, double-blind, placebo-controlled clinical trial, adults presenting with acute nontraumatic headache received 1 g of oral paracetamol prior to randomization, then were assigned to receive either 2 g intravenous MgSO4 in 150 mL saline solution or placebo 150 mL saline solution alone, infused more than 30 minutes. The primary outcome was the treatment success, defined as a ≥30% reduction in the numerical rating s̶cale score at 30 minutes. Secondary outcomes were the need for rescue analgesia, patient satisfaction, and adverse events.
Results: We included 506 patients in MgSO4 group and 522 in placebo group. Success was more frequent in the MgSO4 (78.9 %) versus placebo group (65.1%) (difference 13.8%; 95% confidence interval [CI] 8 to 19); however, all timed numerical rating s̶cale differences were below the 1.3-point accepted threshold for clinical importance. In the MgSO4 group, rescue analgesia was required less frequently (7.1% versus 15.3%; difference -8.2%; 95% CI -12 to -4.3), patient satisfaction was greater (91.7% versus 85.1%; difference 6.6; 95% CI 2.7 to 10), and adverse events were more frequent (15.4% versus 11.1%; difference 4.3; 95% CI 0.1 to 8.4).
Conclusion: Adding intravenous MgSO4 to…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 506 participants or records.
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