Randomized trial of IV valproate vs metoclopramide vs ketorolac for acute migraine

Friedman et al. super(1) reported the findings from a randomized trial comparing singledose IV metoclopramide, valproate, and ketorolac in acute migraine. We have some concerns. The study showed that metoclopramide was more efficacious. However, if adopted as a routine antimigraine treatment in emergency departments it may lead to widespread, repeated use of metoclopramide with potentially serious consequences.