• Ilker Akbas, Meryem Betos Kocak, Abdullah Osman Kocak, Sultan Tuna Akgol Gur, Sinem Dogruyol, Mehmet Demir, and Zeynep Cakir.
• From the Department of Emergency Medicine, Bingol State Hospital, Bingol, Turkey.
• Ann Saudi Med. 2021 May 1; 41 (3): 127-134.

BackgroundMigraine is a prevalent disabling primary headache disorder that is classified into two major types: migraine without aura and migraine with aura. New therapeutic methods to reduce migraine headaches in the emergency department (ED) include intradermal mesotherapy.ObjectiveCompare the efficacy of intradermal mesotherapy versus a systemic therapy in pain control in patients with headache related to migraine without aura.DesignProspective parallel-group randomized controlled trial.SettingUniversity hospital in Turkey.Patients And MethodsPatients 18 years of age and older who were admitted to the ED over a 15-month period with headache related to migraine without aura were eligible for inclusion if they had a VAS score of 4 or above. Patients were randomly allocated to one session of mesotherapy or intravenous dexketoprofen. Changes in pain intensity were measured by the score on a visual analog scale (VAS) at 30, 60, and 120 minutes and 24 hours after treatment. Efficacy was also assessed by the need for use of an analgesic drug within 24 hours, by readmission with the same complaint to the ED within 72 hours, and by adverse effect rates.Main Outcome MeasurePain intensity on the VAS scale.Sample Size148 patients (154 enrolled and treated; 1 patient in the mesotherapy and 5 patients in the systemic therapy group lost to follow up).ResultsPain intensity on the VAS scale decreased from a median score of 8 to 4 in the mesotherapy group and from 8 to 5 in the systemic therapy group. These differences were statistically significant from baseline for all time intervals (P=.001 to 30 minutes, P=.004 to 60 minutes, P=.005 to 120 minutes, and P=.002 to 24 hours). The need to use analgesics and the rate of readmission to the ED were higher in the systemic therapy group (P=.013 and P=.030, respectively). Adverse effect rates were minimal and similar in the study groups during the one-week follow-up period.ConclusionsMesotherapy is more efficacious than intravenous dexketoprofen in the management of acute attack of migraine without aura in the ED.LimitationsUnblinded. Valid for assessing short-term pain relief, but not sufficient to predict long-term efficacy. Not generalizable because single center and small sample size.Conflict Of InterestNone.RegistrationClinicalTrials.gov (NCT04519346).

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