![]() Do not give to patients who take already multiple QT prolonging drugs.Perform EKG monitoring for patients at risk of QTc prolongation.Droperidol IV/IM 1.25-2.75 mg, plus or minus diphenhydramine for extrapyramidal symptoms.Valproate sodium 500-1000 mg IV in 50 mL of NS over 20 minutes (alternatively 10 mg/kg IV, pediatrics, max 500 mg).Magnesium 1-2 g IV over 30-60 minutes, low side effect profile, in treatment of acute migraine attacks.Consider dexamethasone 10 mg IV single dose to prevent recurrence 48-72 hrs post-ED discharge, if history of recurrent headaches.Contraindications to triptans include CV disease, uncontrolled HTN, pregnancy.OR 1-2 sprays IN (may repeat after 2 hours).OR 100 mg PO, may repeat dose x1 after 2 hours, max 200 mg / 24 hours.6 mg SQ or IM, may repeat dose x1 after 1 hour, max 12 mg / 24 hours.Serotonin 5HT1B/1D receptor agonist (e.g.Sumatriptan most effective within 6 hours of headache onset. ![]() Lower doses are shown to be just as effective.Alternative metoclopramide 10 mg IV ( diphenhydramine addition shows no clinical benifit ).Place prochlorperazine in IV bag to reduce chances of side effects from rapid administration.1st line: prochlorperazine (compazine) 10 mg IV (+/- diphenhydramine 25-50 mg IV) + 1 L IVF bolus.If known, treat specific headache type avoid opioid medications if at all possible Consider dexamethasone 10mg IV x 1 to prevent recurrence 48-72 hrs post-ED discharge, if history of recurrent headaches (NNT = 10).Contraindications: cardiovascular disease, use of DHE in previous 24hrs.Contraindications: pregnancy, cardiovascular disease, hypertension.Consider metoclopramide or prochlorperazine as pre-treatment antiemetic.1st line: Prochlorperazine (compazine) 10mg IV (+/- diphenhydramine 12.5mg IV).Make sure you considered other causes of emergent headache.Consider pregnancy test (for medication selection).Fungal ( AIDS, transplant, chemotherapy, chronic steroid use).pyelonephritis, nonspecific viral infection) Cavernous sinus thrombosis or cerebral sinus thrombosis.Idiopathic intracranial hypertension (Pseudotumor Cerebri).Giant cell arteritis of temporal artery (temporal arteritis).If at least 4 of the following "POUNDing" features, LR of migraine is 24 īasilar-type migraine may be associated with fully reversible dysarthria, vertigo, tinnitus, decreased hearing, double vision or ataxia Not better accounted for by another ICHD-3 diagnosis.the aura is accompanied, or followed within 60 minutes, by headache.at least one aura symptom is unilateral.each individual aura symptom lasts 5-60 minutes.two or more aura symptoms occur in succession.at least one aura symptom spreads gradually over ≥5 minutes.Criteria B: At least three of the following six characteristics:.Criteria A: One or more of the following fully reversible aura symptoms:.At least two attacks fulfilling criteria A and B. ![]()
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