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Pharmacologic Management of Acute Migraines in the Emergency Department

Jesani, Jennifer MSN, RN, FNP-BC, CEN; Simerson, Darlie DNP, APRN, FNP-BC, CEN

Advanced Emergency Nursing Journal: April/June 2019 - Volume 41 - Issue 2 - p 150–162
doi: 10.1097/TME.0000000000000229

Migraine headaches account for approximately 1.2 million emergency department (ED) visits annually. Despite the prevalence of this condition, there is little consensus on the best pharmacotherapeutic interventions to use in the ED setting. Guidelines published by the American Headache Society and the Canadian Headache Society offer some direction to ED providers but are not widely utilized. This article reviews the best evidence behind some of the medications frequently used to treat acute migraines in the ED setting, including dopamine receptor antagonists, serotonin receptor agonists, anti-inflammatory medications, opioids, magnesium, valproate, and propofol. The evaluation of patients presenting to the ED with an acute headache, the diagnostic criteria for migraines, and implications for advanced practice are also discussed.

Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois.

Corresponding Author: Jennifer Jesani, MSN, RN, FNP-BC, CEN, Marcella Niehoff School of Nursing, Loyola University Chicago, 2160 S. First Ave, Bldg 125, Maywood, IL 60153 (

Disclosure: The authors report no conflicts of interest.

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