Migraine Treatment

Overview

• Treat in a quiet, dark room
• Beware of sudden onset headache or 'worse-ever headache' in a migraine sufferer
• Do not make the diagnosis of first onset migraine in a person over 30 y.o.
• Opioids rarely have a place in ED treatment of migraine

DRUG TREATMENT

Aim to completely relieve the headache to prevent relapse and re-presentation

First line

• Prochlorperazine (Stemetil) 12.5mg IV or Metoclopramide (Maxolon) 10mg IV
• Paracetamol 500 mg (3 tablets) or aspirin 300 mg (3 tablets) - when able to tolerate (avoid aspirin if possible intracranial bleed)
• IV Normal saline 1-3 litres stat (if vomiting or dehydrated)

Repeat dose Prochlorperazine or Metoclopramide as necessary

Be aware of dystonic reactions

Second line

• IV Normal saline 1000 ml + 0.1mg/kg chlorpromazine

Monitor for hypotension

Repeat dose Chlorpromazine if necessary

Third line

• IV Promethazine 25 mg

Fourth line (with ED consultant/registrar approval)

•  sumatriptan 6 mg SC (if responsive then GP should be advised)