Migraine in the ER: Treatment Guidelines From the American Headache Society
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During a migraine attack, going to the ER can seem like a nightmare come true. The lights are blaring, sounds are loud and unpredictable, and the odors of a hospital turn your already-nauseated stomach. Having an unwelcoming environment exacerbate your symptoms is awful, but that’s a minor irritation compared to having to fight for treatment. A person goes to the ER during a migraine attack with one goal: to reduce the severity of an unbearable attack. Yet, they often feel like they’re treated not as people in pain, but as addicts trying to get high. To help patients get better care, the American Headache Society has issued new, research-based guidelines for treating migraine in the ER.

Recommended medications for the first ER visit

For a patient’s first visit to the ER during a migraine attack, the experts who created the guidelines recommend an Imitrex (sumatriptan) injection and Reglan (metoclopramide) and Compazine (prochlorperazine) by IV. Patients should also be given a prescription for dexamethasone, a steroid, to take at home to prevent the migraine from recurring.

Alternate list of drug options

The expert panel is aware that those drugs may not be effective for every patient or that patients may have already reached their maximum number of triptans for the day. For these patients, the guidelines include alternate lists of drugs. Which medications an ER chooses to use depends on each patient’s needs. It’s best to talk with your doctor during a regular appointment about which medications they would recommend for you in the ER. Ask for a letter outlining the recommendations and be sure to take it with you to the ER. Not every ER will follow the letter’s guidance, but having suggestions from your doctor increases the chance you’ll be given a treatment that’s effective for you.

Strong research to support drug efficacy

The medications included in the guidelines were chosen after a comprehensive review of emergency migraine treatment. Experts looked at 68 studies that used 28 different injectable medications. Five of the studies also assessed steroids for preventing migraine recurrence after a patient leaves the ER. Medications were evaluated for how effectively they reduce a migraine attack’s severity and also for risks and adverse events. The medications recommended all have strong research to support their efficacy in the ER.

ERs throughout the country currently vary widely in the treatments they use for migraine. Benjamin W. Friedman, M.D., a member of the expert panel, said that about 20 different medication combinations are used and some of them are not very effective. The American Headache Society issued these guidelines to help patients find effective relief without risking future complications, like medication overuse headache.

view references
  1. Anderson, P. (2016, Jun 17). New AHS Consensus on Emergency Migraine Management. Medscape. Retrieved on Jun 17, 2016 from http://www.medscape.com/viewarticle/864989.
  2. Orr, S. L.; Friedman, B. W.; Christie, S.; Minen, M. T.; Bamford, C.; Kelley, N. E.; Tepper, D. (2016). Management of Adults With Acute Migraine in the Emergency Department: The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies. Headache: The Journal of Head and Face Pain 56.6 (2016): 911-940.
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