Migraine: pharmacotherapy in the emergency department

Abstract

ⅷ Migraine can be a disabling condition for the sufferer. For the small number of patients for whom home therapy fails and who seek treatment in an emergency department, several therapeutic options are available. I review the evidence regarding the effectiveness and safety of the following therapies: the phenothiazines, lignocaine (lidocaine), ketorolac, the ergot alkaloids, metoclopramide hydrochloride, the "triptans," haloperidol, pethidine (meperidine hydrochloride), and magnesium sulfate. Based on available evidence, the most effective agents seem to be prochlorperazine, chlorpromazine and sumatriptan, each of which has achieved greater than 70% efficacy in several studies.

A Case Report of Ophthalmoplegic Migraine: a Differential Diagnosis of Third Nerve Palsy

“…The quick resolution of the headache may have been due to treatment with prochlorperazine, which is one of the most effective agents in the acute treatment of migraine (10)(11)(12)(13) or to the natural history of the migraine. The third nerve palsy took a longer time to recover, with complete resolution after 8 weeks.…”

L’évaluation des céphalées à l’urgence, tout un casse-tête!

“…En effet, le métoclopramide a d'abord un effet anti-nauséeux, mais il est également reconnu dans la littérature pour son effet antimigraineux [11][12]. Son mécanisme d'action envers les migraines est peu connu, mais il est suggéré qu'il obtient son effet grâce à son mécanisme antagoniste des récepteurs dopaminergiques [13]. Ce traitement agira donc à deux niveaux chez notre patiente qui éprouve des nausées en plus d'une migraine.…”

ED Treatment of Migraine Headache: Factors Influencing Pharmacotherapeutic Choices

“…These include nonsteroidal antiinflammatory drugs (NSAIDs), dopamine‐antagonist antiemetics, ergotamines, 5HT 1 receptor agonists, mixed opioid agonist‐antagonists, and opioid agonists. Each of these classes of medications has been reviewed previously, and Canadian and US guidelines have been published to assist clinicians in their use 3–6 . These guidelines advocate the use of non‐opioid medications (specifically 5HT 1B/1D receptor agonists [triptans], dihydroergotamine [DHE], and antiemetics with antiheadache properties) as the initial treatment for acute migraines.…”