Migraine Headache treatment in the ED
Posted by dkwinter

First line:

  • 30-60 mg Toradol IM. Onset 30-60 minutes.
    • OR
  • 20-40 mg Relpax (Eletriptan) PO. May give second dose 2 hours later if initial dose was 20 mg (max daily dose is 40 mg). Onset 1.5-2 hours.

Second line:

  • 1L IV fluid
    • PLUS
  • 10 mg Stemetil (Prochlorperazine) IM/IV/PO (all same dose). Typical antipsychotic, antidopaminergic acting at CTZ.
    • OR
  • 10 mg Maxeran (Metoclopramide) IM/PO/IV (over 1-2 min). Antidopaminergic, antiserotonergic at CTZ.

Third line:

  • 1mg Migranal (Dihydroergotamine) SC/IM/IV, ONLY IF NO TRIPTAN within prior 24 hours and NO HTN. Vasoconstricts vascular smooth muscle.