Single-dose intravenous tramadol for acute migraine pain in adults: a single-blind, prospective, randomized, placebo-controlled clinical trial

Abstract

Background: Tramadol, an atypical opioid, is a narcotic analgesic used for pain management. A search of the current literature found no studies examining the efficacy of intravenous tramadol on migraine pain.

Objective: The aim of this study was to investigate the efficacy and tolerability of a single dose of intravenous tramadol hydrogen chloride 100 mg in comparison with placebo in patients presenting with migraine.

Methods: Adult migraineurs admitted consecutively to the emergency department of the Kocaeli University Hospital were enrolled in this single-blind (patients), prospective, randomized, placebo-controlled clinical trial. Patients were randomized to receive a 30-minute infusion of either intravenous tramadol (n = 17; 100 mg in 100-mL saline) or placebo (n = 17; 100-mL saline). Pain response was defined as a decrease of visual analogue scale (VAS) (0-100 mm) score to <50% of the pretreatment (baseline) value and a decrease of 4-point verbal scale (FPVS) score (0 = none, 1 = mild, 2 = moderate, 3 = severe) to mild or none. Pain-free response was defined as a decrease of both VAS and FPVS scores to 0. Pain was assessed at baseline and at 30 minutes and 1 hour after treatment completion. Migraine symptoms (eg, photophobia, phonophobia, nausea, vomiting) and adverse events (AEs) were assessed at the same time. A follow-up was also conducted by phone 24 hours after treatment.

Results: Forty-four migraineurs were screened and 34 (28 women and 6 men; mean [SD] age, 39.5 [10.4] years; all were white) were enrolled in the study. Each group contained 11 patients with severe pain and 6 patients with moderate pain at baseline FPVS. At the end of 1 hour, pain response was reported by significantly more patients in the tramadol group than in the placebo group (12 [70.6%] vs 6 [35.3%]; P = 0.040). Pain-free response was reported by 5 (29.4%) patients in the tramadol group and 2 (11.8%) patients in the placebo group, although the difference was not statistically significant. Symptoms associated with migraine were also relieved in all patients reporting pain response. No AEs were observed. However, at the 24-hour follow-up, 1 patient in the tramadol group reported transient blurred vision and dizziness within the day of infusion. Headache recurrence was reported by 2 (16.7%) of the 12 patients with pain response in the tramadol group and 1 (16.7%) of 6 patients with pain response in the placebo group.

Conclusions: Intravenous tramadol appeared to be more effective than placebo in pain response rate at the end of the first hour. The slow infusion of tramadol 100 mg in 100-mL saline solution was well tolerated in this group of adult migraineurs.