Migraine

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ED cocktail

Urgent Care cocktail (we don't have Reglan)

If neither cocktail gets pain to a manageable level, try Decadron/Dex 8mg Metoclopramide 10 mg IV Ketorolac 15 mg IV Acetaminophen 975 mg PO Dexamethasone 10 mg IV dexamethasone (10 to 25 mg intravenously or intramuscularly)

ANTIDOPAMINERGICS:

Any of the typical medications, whatever available readily, will work, including: metoclopramide 10 mg IM, prochlorperazine 10 mg IM, or promethazine 25 mg IM. The onset of action of all three medications via the IM route is between 10-20 minutes.[2-4]

Anti-Emetics:

Zofran/ondansetron

Phenergen/promethazine

SUMATRIPTAN:

Frequently forgotten are triptains and anecdotally do not seem to be the go-to for many ED providers, but 6 mg subcutaneous has shown benefit in treating patient with primary headache disorder.[10]

No diphenhydramine

Diphenhydramine doesn’t work for headaches [208 patient RCT, REF].

Diphenhydramine doesn’t prevent metoclopramide-associated akathisia

http://brownemblog.com/blog-1/2019/7/26/alternatives-to-the-migraine-cocktail

IV prochlorperazine, IV ketorolac, IV diphenhydramine, IV dexamethasone, and/or IV normal saline.[1]

Fluids

Fluids do not help relieve headaches. Administer only if dehydrated, they often are, due to vomiting.

Curbsiders episode #4 link

Dr. Solomon's definition

New class of meds: CGRP for those suffering from more than 2 migraines/month.