Despite Variations, Evidence Provides Clear Road Map for Adult Patients Presenting with Acute Migraine

Although there is solid evidence to support how patients presenting with migraine headaches should be treated in the ED, studies show there is wide variation in the care that these patients receive. To reduce this variation, experts have unveiled guidelines based on a review of 68 randomized, controlled trials that looked at 28 injectable migraine medications. Investigators did not present any A-level, or "must offer," recommendations, but four medications received B-level, or "should offer," recommendations. The authors advised that intravenous metoclopramide and prochlorperazine, as well as subcutaneous sumatriptan, should be offered as a first-line treatment to adults who present to the ED with an acute migraine. Investigators also advised that dexamethasone should be offered to these patients to prevent their acute headache from recurring over the short term. Researchers noted that injectable morphine and hydromorphone should be avoided as a first-line therapy.