MgSO4 vs Metoclopramide for Headache in Pregnant Women
MgSO4 vs Metoclopramide for Headache in Pregnant Women
The study will compare effectiveness of intravenous magnesium sulfate to that of intravenous
 metoclopramide (Reglan®) for acute headache in pregnant women. We will randomize pregnant
 women who present to our emergency department with chief complaint of headache to magnesium
 sulfate 2 grams intravenously or metoclopramide 10 mg intravenously; both groups will receive
 acetaminophen (Tylenol®) 1 gram orally and normal saline 1 liter intravenously. Headaches are
 common during pregnancy, related to hormonal changes, altered sleep patterns and psychosocial
 stressors. Common medications for headache such as non-steroidal antiinflammatories or
 triptans are typically avoided during pregnancy due to concern for fetal effects. Women, and
 their physicians, are often uncertain regarding available medication options with justifiable
 safety profiles during pregnancy.
Metoclopramide and prochlorperazine (Compazine®), antiemetic dopamine receptor antagonists,
 are widely used for headache treatment in North American emergency departments.
 Metoclopramide, FDA pregnancy category B, is used in clinical practice for acute headache in
 pregnant women. Small studies have found magnesium sulfate to be effective in migraine,
 tension and cluster headaches, although there is no data regarding efficacy or tolerability
 in pregnant women.

 Our study would be similar to a Turkish study published in 2004 which compared magnesium
 sulfate to metoclopramide for acute headache treatment in nonpregnant individuals; they found
 the drugs equally effective 30 minutes after administration. Serum magnesium levels in
 pregnant women are often lower than in nonpregnant women; magnesium deficiency has been
 explored as contributing to headache frequency and severity. Magnesium sulfate use has been
 well established during pregnancy for decades, administered intravenously to delay labor or
 to women with preeclampsia for 24 to 48 hours, initially with 4 to 6 gram bolus then 2 grams
 per hour. For headache treatment, magnesium sulfate dose would be far lower, 2 grams. We
 would like to determine the efficacy and tolerability of magnesium sulfate for headache
 relief in pregnant women, as well as evaluate efficacy of metoclopramide in pregnant women.
 We do not find published randomized trials evaluating headache treatment in pregnant women.
Inclusion Criteria:

 -  Pregnant, 18-75

 -  Headache rated 4 or greater on a 0-10 pain scale

 Exclusion Criteria:

 -  New objective neurologic abnormality at the time of exam

 -  Temperature >100.4

 -  Allergy or intolerance to study medications

 -  Suspected of confirmed preeclampsia/eclampsia

 -  Complete heart block

 -  Hypotension, SBP<85

 -  Myasthenia gravis

 -  End stage renal failure