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Emergency Department and Inpatient Management of Status Migrainosus and Intractable Headache

Rozen, Todd D. MD, FAAN

CONTINUUM: Lifelong Learning in Neurology: August 2015 - Volume 21 - Issue 4, Headache - p 1004–1017
doi: 10.1212/CON.0000000000000191
Review Articles

Purpose of Review: This article discusses the treatment of status migrainosus in the emergency department and the treatment of intractable migraine in an inpatient setting.

Recent Findings: Multiple agents of various drug classes have been tried for the treatment of acute migraine in the emergency department, but few have adequate medical evidence to support their use. Opioids, which are less effective than other medications used for the acute treatment of migraine and also carry the risk of adverse CNS side effects, habituation, and addiction, have been prescribed for migraine in the emergency department at an increasing rate over the last decade, which is a worrisome trend. Very few patients with migraine derive sustained relief from pain after emergency department treatment, and most have a high frequency of headache recurrence.

Summary: Treatment of status migrainosus and intractable migraine should focus on adequate fluid hydration and combination IV therapy with multiple nonopioid medications from multiple drug classes. Dopamine receptor antagonists appear to have some of the highest medical evidence for efficacy.

Address correspondence to Dr Todd D. Rozen, Geisinger Specialty Clinic, MC 37-31, 1000 East Mountain Blvd, Wilkes-Barre, PA 18711, tdrozmigraine@yahoo.com.

Relationship Disclosure: Dr Rozen reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Rozen discusses the unlabeled/investigational use of magnesium sulfate, dopamine receptor antagonists (metoclopramide, promethazine, prochlorperazine, droperidol, chlorpromazine), ketorolac, levetiracetam, methylprednisolone, and dexamethasone for the treatment of migraine headache.

© 2015 American Academy of Neurology
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