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Emergency Department Migraine Headache CareAka: Migraine Headache Care in the Emergency Department

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  1. See Also
    1. Headache Evaluation
    2. Migraine Headache
    3. Migraine Headache Management
    4. Migraine Headache Management in Children
    5. Migraine Abortive Management
    6. Migraine Prophylaxis
    7. Headache Red Flags
    8. Headache General Measures
    9. Migraine Medications in Pregnancy
    10. Migraine Medications in Breast Feeding
    11. Headache in Pregnancy
  2. Indications
    1. Migraine Headache refractory to home care (6-72 hours)
  3. Antiemetics
    1. Dopamine-antagonists are preferred
      1. Prochlorperazine (Compazine) with IV hydration
        1. Often effective for aborting intractable Headache
        2. Adults: 10 mg IV
        3. Child: 0.15 mg/kg IV
      2. Metoclopramide (Reglan) 10 mg IV
      3. Droperidol 0.625 to 2.5 mg IV or IM
      4. Consider Diphenhydramine (Benadryl) for Dyskinesia
    2. Avoid agents less effective in treating Headache
      1. Promethazine (Phenergan) 12.5 mg IV
      2. Hydroxyzine
  4. Serotonin Agonist
    1. Dihydroergotamine mesylate (DHE)
    2. Triptans (e.g. Sumatriptan or Imitrex)
  5. Anticonvulsant: Valproic Acid (Depacon)
    1. Depacon 300-1000 mg in 100 cc NS IV over 30 minutes
  6. Antipsychotics with Analgesic and Antiemetic properties
    1. Chlorpromazine (Thorazine) 12.5 mg IV q20 min prn x3
    2. Haloperidol (Haldol) 5 mg IV
      1. Pre-bolus 500 to 1000 cc of IV fluids
  7. Analgesic or Anti-inflammatory
    1. Toradol 60 mg IM
    2. Dexamethasone IV
    3. Hydrocortisone or Methylprednisolone IV
    4. Opioids (avoid if possible)
      1. Still used in 47% of emergency visits
  8. References
    1. Diamond (1997) Postgrad Med 101(1):169
    2. Kabbouche (2001) Pediatrics 107:e62
    3. Kelly (2000) West J Med 173:189
    4. Newman (1998) Neurol Clin 16(2):285
    5. Vinson (2003) Ann Emerg Med 41:90

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