2014 Jul 12.Fortuitous Finding – IV Propofol: Unique Effectiveness in Treating Intractable Migraine. Multiple hypotheses exist involving cerebral vessels, nerves, inflammation, intracranial pressure, meningeal irritation, and/or intracerebral serotonergic projections. Enter your email address to receive notifications of new posts by email.This blog aims to disrupt how medical providers and trainees can gain public access to high-quality, educational content while also engaging in a dialogue about best-practices in EM and medical education. I recommen a bupivicaine occipital nerve block to any patient who I think could have occipital neuralgia, review the anatomy, make sure I'm not in the artery, and put in a nice dose of bupivicaine.Opioids don’t work for headache. Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department-Based Randomized Clinical Trial. Headache. The effect of single-dose porpofol injection on pain and quality of life in chronic daily headaches: a RDBCT. Headache.

The ASASUMAMIG Study Group. A double-blind, double-dummy, randomized, multicenter, parallel group study. I never* give opioids for headache.

IM works fine if the patient doesn’t have an IV – most headache patients don’t need labs or IV fluids so no reason to start one routinely and a lot of even severe headaches are suitable for fast track. While often used as an adjunct in the ED, there have not been any independent studies for efficacy in treatment of acute headaches.4) Droperidol (Inapsine): Dosed at 2.5mg to 5mg IM or IV.

A double-blind, double-dummy, randomized, multicenter, parallel group study. Diener HC. Inflammation might contribute to acute migraine, and, therefore, corticosteroids could be a helpful treatment. “Because most studies in the review treated patients with IV dexamethasone at a median dose of 12.8 mg, the literature appears to indicate that this is the proper dose to use. But never push IV Benadryl – it gets you high [Unless the patient has been vomiting a lot or has another reason to be volume down, there is little reason to give IV fluids [I’ll be honest, I don’t give triptans, except in the rare cases where patients know they work for them.

BMJ 2008 Jun. Detsky et. Much of what we do implicitly is not clear to the patient – our across-the-room gestalt, our assessment and thought processes.

Annals of EM. THIS BLOG IS NOT ENDORSED BY OR SPONSORED BY NORTHWESTERN UNIVERSITY, FEINBERG SCHOOL OF MEDICINE, NORTHWESTERN MEMORIAL HOSPITAL OR ANY OTHER AFFILIATE. There have been randomized controlled studies that have both demonstrated greater efficacy than Compazine and superiority to placebo5) Haloperidol (Haldol): Dosed at 5mg IV or IM.
Acad Emerg Med.
January 2016. January 2016. Headache during pregnancy can be a painful problem. The use of subdissociative-dose ketamine for acute pain in the emergency department. Last night I had to make the dreaded trip to the ER for a migraine going on three days. Usually the patient’s already taken their home dose, and it seems like most patients have missed the window for effectiveness by the time they’re seeing me. Sin B et al. - AR15.Com Archive Still alive. Randomized, Placebo-Controlled Evaluation of Prochlorperazine Versus Metoclopramide for Emergency Department Treatment of Migraine Headaches.Colman et al Paraenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. We strive to reshape medical education and academia in their evolution beyond the traditional classroom.Would you like to contribute? 67(1):32-39.Brown CR, Moodie JE, Wild VM, Bynum LJ. Droperidol for the treatment of acute migraine headaches. 2002 Jun;42(6):515-8.Rozen TD. The evidence is weak at best, but it might help and is pretty safe, so why not.I usually re-dose metoclopramide at this point, but if their current or prior headaches are generally refractory, I often switch to haloperidol (2.5mg IV or IM).Key points in communicating with the patient and evaluating them for discharge:I don’t have a silver bullet to fix their headache.

;336(7657):1359–1361Metoclopramide for Pain and Nausea in Patients with Migraine. PO ibuprofen is likely as effective as ketorolac, and getting a shot doesn’t seem to have a placebo effect (if nothing else, this study is worth reading for the amazing design [Steroids don’t fix the headache today but they decrease recurrence in some patients. Headaches account for up to 4.5% of emergency room visits per year3. BMJ 2008 Jun. Migraine Cocktail Decadron Gain Weight Dizziness Nausea. Going beyond the standard “headache cocktail”… 8. J Emerg Med.

2009 3Dec;109(6):1972-80.Soleimanpour et al. Treatment of headaches in the ED with lower cervical intramuscular bupivacaine injections: a 1-year retrospective review of 417 patients. Let us know your thoughts on how we can improve our website, don't be shy!

By J Bel August 5, 2016 at 5:57 pm. Pharmacotherapy. Dosed at 10mg IV or IM. In 4 placebo controlled studies was noted to have a positive effectiveAfter reviewing the evidence, the following recommendations for treating mild to moderate headache pain include We are actively recruiting both new topics and authors. Am Fam Physician. The majority of these have a benign cause, but serious causes can be devastating, and a thorough H&P with an eye toward "red flag" symptoms is important in ED evaluation. Multiple hypotheses exist involving cerebral vessels, nerves, inflammation, intracranial pressure, meningeal irritation, and/or intracerebral serotonergic projections.