This week in the BMJ
Volume 329, Number 7479, Issue of 11 Dec 2004Treat migraine with parenteral metoclopramide
Treat migraine with parenteral metoclopramide
Parenteral metoclopramide is a highly effective treatment for migraine headaches and should be the drug of first choice for treatment of acute migraine in emergency departments. Colman and colleagues (p 1369) performed a meta-analysis of 13 eligible trials including 655 adults. Metoclopramide was almost three times as effective as placebo in relieving migraine pain, and only four patients need to be treated with metoclopramide to enable one additional patient to achieve significant reduction in pain.
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Occupational therapy gets stroke patients out of the house
Occupational therapy improves stroke patients' outdoor mobility. Logan and colleagues (p 1372) randomly assigned 168 patients who had had a stroke in the previous 36 months to receive leaflets describing local transport services for disabled people, along with up to seven therapy sessions by an occupational therapist, or to receive leaflets only. Patients who had therapy were more likely to say they got out of the house as often as they wanted; after four and 10 months they had made more outdoor journeys than patients in the control group.
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Folate in pregnancy may need caution
Taking folate supplements in pregnancy could contribute to a greater risk of breast cancer later in life—but this may be a chance finding and needs confirmation. Charles and colleagues (p 1375) followed up 2928 women who had taken part in a randomised controlled trial in the 1960s of low and high doses of folate supplementation in pregnancy versus placebo. By September 2002, 210 of these women had died. Compared with women who had received placebo, in women who had been randomised to high doses of folate, all cause mortality was about a fifth greater, and the risk of deaths attributable to breast cancer was doubled.
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Spinal manipulation gives value for money
Most patients with acute back pain improve over time, but adding spinal manipulation followed by exercise to standard care moderately improves results. The UK BEAM trial team (p 1377) randomised 1334 patients with low back pain to additional exercise classes, spinal manipulation, or manipulation followed by exercise or to "best care" in general practice. Manipulation, with or without exercise, improved symptoms more than best care alone after three and 12 months. However, analysis of the cost utility of different strategies shows that manipulation alone probably gives better value for money than manipulation followed by exercise (p 1381).
Non-invasive cardiology excels
Developments in non-invasive imaging techniques are improving the visualisation of anatomy and functioning of the heart, providing cardiologists with better diagnostic information and guidance on treatment and risk stratification. Prasad and colleagues (p 1386) reviewed trials and systematic reviews on non-invasive cardiac imaging published between 2000 and 2004. They inform us of the newest techniques and remind us of the classics, reporting among others on cardiovascular magnetic resonance imaging, myocardial perfusion scintigraphy single photon emission computed tomography, and ambulatory blood pressure monitoring.
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Think again about childhood depression
In 2003, more than 50 000 children were prescribed antidepressants in the United Kingdom, even though antidepressants have been shown to be largely ineffective, and possibly dangerous, in this age group. On p 1394 Timimi re-examines childhood and adolescent depression, discussing contemporary cultural beliefs and the organisation of family life as well as presenting currently available evidence. Arguing that sociocultural changes and a change in the meaning given to childhood problems have probably caused increasing happiness in young people, she proposes a multiperspective approach with more emphasis on non-medical treatments to deal with children's unhappiness and their families.
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