Rescue Therapy for Acute Migraine, Part 1: Triptans, Dihydroergotamine, and Magnesium

Kelley, Nancy E.; Tepper, David

doi:10.1111/j.1526-4610.2011.02062.x

Cited by 67 publications

(42 citation statements)

References 61 publications

(62 reference statements)

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“…As with adults who utilize the ER for their headache exacerbations, pediatric headache experts have shied away from the prescribing of narcotics . Judicial use of Intravenous fluids, NSAIDs, dopaminergic agents, magnesium, valproate, and Dihydroergotamine (DHE) have been used successfully 24,65,79‐83. Steroids are used as anti‐inflammatory agents, and their roles in the ER settting have been summarized well for adults …”

Section: Er and Inpatient Managementmentioning

confidence: 99%

Pediatric Headache: Where Have We Been and Where Do We Need to Be

2014

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Section: Er and Inpatient Managementmentioning

confidence: 99%

Pediatric Headache: Where Have We Been and Where Do We Need to Be

2014

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“…Although adult headache studies report the common side effects with i.v. magnesium, including flushing from 8% to almost all patients in another cohort, lightheadedness, and burning at the site of infusion in up to 25%, these were not as common in our sample of adolescents and could be partly attributed by our slow infusion rate (6). …”

Section: Discussionmentioning

confidence: 63%

“…Some studies have shown i.v. magnesium to be effective for migraines and associated features, and others have shown no improvement compared with placebo (5,6,9,10). To our knowledge, there are no controlled studies in the pediatric population.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Magnesium As Acute Treatment for Headaches: A Pediatric Case Series

Gertsch

Loharuka²,

Wolter‐Warmerdam

et al. 2014

The Journal of Emergency Medicine

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Background Acute i.v. treatment for pediatric headache varies widely. Objectives Our aim was to describe our experience with i.v. magnesium for acute treatment of pediatric headache. Methods We reviewed the electronic medical records of all patients ages 5 to 18 years old treated with a standard dose of i.v. magnesium for headache at our institution from January 2008 to July 2010. Charts were assessed for headache diagnosis, prior medications given, side effects, tolerability, and response to treatment. Individuals were excluded if they had an underlying unstable medical condition or a secondary etiology for headache. Only first encounters were included if the patient had multiple encounters. Results There were 34 episodes of children who received i.v. magnesium in the emergency department (ED) or hospital. Of these, 14 were excluded because the patients had complex medical conditions (n = 6), they were repeat encounters (n = 7), or known secondary etiology for the headache (n = 1). Of the 20 included charts (range 13–18 years old), 5 had migraine, 4 had tension-type headache, and 11 had status migrainosus. Thirteen were treated in the ED and seven as an inpatient with a standard i.v. dose of magnesium. Ten of thirteen adolescents receiving i.v. magnesium in the ED were admitted for further headache treatment but not for side effects, and three were discharged home. Side effects of treatment included pain (1 of 20), redness (1 of 20), burning (1 of 20), and decreased respiratory rate without change in oxygenation (1 of 20). Conclusions In our case series, adolescents given i.v. magnesium as an abortive therapy for headache experienced minimal side effects and further studies should evaluate for effectiveness.

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“…For example, they have had a myocardial infarction and an ulcer so both triptans and NSAIDs are contraindicated, over‐the‐counter medications do not work, and they do not want to take or the providers do not want to give opioids. Third, most headache specialists do not report prescribing rescue medication, a major potential strategy for preventing ED visits . These medications can be given if the typical migraine acute medication does not work; migraine rescue medications provide relief at home, so the patient does not have to go to the emergency room.…”

Section: Discussionmentioning

confidence: 99%