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. 1992 Jun;38:1451–1456.

New Prescriptions for Migraine in the Emergency Department

Treating a common affliction and presenting symptom

Peter L Lane
PMCID: PMC2146148  PMID: 21221402

Abstract

Migraine headache is a common affliction and presenting symptom in the emergency department. Its diagnosis is entirely clinical, and the treating physician should ensure precise diagnosis before commencing therapy. General non-pharmacological measures and oral medications are usually effective in relieving the symptoms. Occasionally, patients with fixed migraines require parenteral therapy. Some medications used for migraine are antiemetic agents, ergot preparations, narcotic agents, phenothiazines (particularly chlorpromazine), and newer selective serotonin agonists.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bell R., Montoya D., Shuaib A., Lee M. A. A comparative trial of three agents in the treatment of acute migraine headache. Ann Emerg Med. 1990 Oct;19(10):1079–1082. doi: 10.1016/s0196-0644(05)81507-0. [DOI] [PubMed] [Google Scholar]
  2. Couch J. R., Jr, Diamond S. Status migrainosus: causative and therapeutic aspects. Headache. 1983 May;23(3):94–101. doi: 10.1111/j.1526-4610.1983.hed2303094.x. [DOI] [PubMed] [Google Scholar]
  3. Dhopesh V., Anwar R., Herring C. A retrospective assessment of emergency department patients with complaint of headache. Headache. 1979 Jan;19(1):37–42. doi: 10.1111/j.1526-4610.1979.hed1901037.x. [DOI] [PubMed] [Google Scholar]
  4. Diamond S., Medina J. L. Review article: current thoughts on migraine. Headache. 1980 Jul;20(4):208–212. doi: 10.1111/j.1526-4610.1980.hed2004208.x. [DOI] [PubMed] [Google Scholar]
  5. Dickman R. L., Masten T. The management of non-traumatic headache in a university hospital emergency room. Headache. 1979 Nov;19(7):391–396. doi: 10.1111/j.1526-4610.1979.hed1907391.x. [DOI] [PubMed] [Google Scholar]
  6. Edmeads J. G. Migraine. CMAJ. 1988 Jan 15;138(2):107–113. [PMC free article] [PubMed] [Google Scholar]
  7. Edmeads J. Cerebral blood flow in migraine. Headache. 1977 Sep;17(4):148–152. doi: 10.1111/j.1526-4610.1977.hed1704148.x. [DOI] [PubMed] [Google Scholar]
  8. Friedman A. P. Overview of migraine. Adv Neurol. 1982;33:1–17. [PubMed] [Google Scholar]
  9. Gallagher R. M. Emergency treatment of intractable migraine. Headache. 1986 Feb;26(2):74–75. doi: 10.1111/j.1526-4610.1986.hed2602074.x. [DOI] [PubMed] [Google Scholar]
  10. Goldstein M., Chen T. C. The epidemiology of disabling headache. Adv Neurol. 1982;33:377–390. [PubMed] [Google Scholar]
  11. Hakkarainen H., Parantainen J., Gothoni G., Vapaatalo H. Tolfenamic acid and caffeine: a useful combination in migraine. Cephalalgia. 1982 Dec;2(4):173–177. doi: 10.1046/j.1468-2982.1982.0204173.x. [DOI] [PubMed] [Google Scholar]
  12. Johnson E. S., Ratcliffe D. M., Wilkinson M. Naproxen sodium in the treatment of migraine. Cephalalgia. 1985 Mar;5(1):5–10. doi: 10.1046/j.1468-2982.1985.0501005.x. [DOI] [PubMed] [Google Scholar]
  13. Kudrow L. Paradoxical effects of frequent analgesic use. Adv Neurol. 1982;33:335–341. [PubMed] [Google Scholar]
  14. Lane P. L., McLellan B. A., Baggoley C. J. Comparative efficacy of chlorpromazine and meperidine with dimenhydrinate in migraine headache. Ann Emerg Med. 1989 Apr;18(4):360–365. doi: 10.1016/s0196-0644(89)80570-0. [DOI] [PubMed] [Google Scholar]
  15. Lane P. L., Ross R. Intravenous chlorpromazine--preliminary results in acute migraine. Headache. 1985 Sep;25(6):302–304. doi: 10.1111/j.1526-4610.1985.hed2506302.x. [DOI] [PubMed] [Google Scholar]
  16. Leicht M. J. Non-traumatic headache in the emergency department. Ann Emerg Med. 1980 Aug;9(8):404–409. doi: 10.1016/s0196-0644(80)80152-1. [DOI] [PubMed] [Google Scholar]
  17. Mathew N. T., Reuveni U., Perez F. Transformed or evolutive migraine. Headache. 1987 Feb;27(2):102–106. doi: 10.1111/j.1526-4610.1987.hed2702102.x. [DOI] [PubMed] [Google Scholar]
  18. O'Brien M. D. Cerebral blood changes in migraine. Headache. 1971 Jan;10(4):139–143. doi: 10.1111/j.1365-2524.1971.hed1004139.x. [DOI] [PubMed] [Google Scholar]
  19. Peatfield R. C., Petty R. G., Rose F. C. Double blind comparison of mefenamic acid and acetaminophen (paracetamol) in migraine. Cephalalgia. 1983 Jun;3(2):129–134. doi: 10.1046/j.1468-2982.1983.0302129.x. [DOI] [PubMed] [Google Scholar]
  20. Pfaffenrath V., Reiter M. Medikamentöse Therapie der Migräne. Wien Med Wochenschr. 1988 Dec 31;138(23-24):591–599. [PubMed] [Google Scholar]
  21. Raskin N. H. Repetitive intravenous dihydroergotamine as therapy for intractable migraine. Neurology. 1986 Jul;36(7):995–997. doi: 10.1212/wnl.36.7.995. [DOI] [PubMed] [Google Scholar]
  22. Ross-Lee L., Heazlewood V., Tyrer J. H., Eadie M. J. Aspirin treatment of migraine attacks: plasma drug level data. Cephalalgia. 1982 Mar;2(1):9–14. doi: 10.1046/j.1468-2982.1982.0201009.x. [DOI] [PubMed] [Google Scholar]
  23. Sircuteri F., Del Bene E., Anselmi B. Fenfluramine headache. Headache. 1976 Sep;16(4):185–188. doi: 10.1111/j.1526-4610.1976.hed1604185.x. [DOI] [PubMed] [Google Scholar]
  24. Taylor G. J., Cohen B. Ergonovine-induced coronary artery spasm and myocardial infarction after normal delivery. Obstet Gynecol. 1985 Dec;66(6):821–822. [PubMed] [Google Scholar]
  25. Tek D. S., McClellan D. S., Olshaker J. S., Allen C. L., Arthur D. C. A prospective, double-blind study of metoclopramide hydrochloride for the control of migraine in the emergency department. Ann Emerg Med. 1990 Oct;19(10):1083–1087. doi: 10.1016/s0196-0644(05)81508-2. [DOI] [PubMed] [Google Scholar]
  26. Tfelt-Hansen P., Jensen K., Vendsborg P., Lauritzen M., Olesen J. Chlormezanone in the treatment of migraine attacks: a double blind comparison with diazepam and placebo. Cephalalgia. 1982 Dec;2(4):205–210. doi: 10.1046/j.1468-2982.1982.0204205.x. [DOI] [PubMed] [Google Scholar]
  27. Tfelt-Hansen P., Olesen J., Aebelholt-Krabbe A., Melgaard B., Veilis B. A double blind study of metoclopramide in the treatment of migraine attacks. J Neurol Neurosurg Psychiatry. 1980 Apr;43(4):369–371. doi: 10.1136/jnnp.43.4.369. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Tfelt-Hansen P., Olesen J. Effervescent metoclopramide and aspirin (Migravess) versus effervescent aspirin or placebo for migraine attacks: a double-blind study. Cephalalgia. 1984 Jun;4(2):107–111. doi: 10.1046/j.1468-2982.1984.0402107.x. [DOI] [PubMed] [Google Scholar]
  29. Tfelt-Hansen P., Olesen J. Methodological aspects of drug trials in migraine. Neuroepidemiology. 1985;4(4):204–226. doi: 10.1159/000110232. [DOI] [PubMed] [Google Scholar]
  30. Tfelt-Hansen P., Olesen J. Paracetamol (acetaminophen) versus acetylsalicylic acid in migraine. Eur Neurol. 1980;19(3):163–165. doi: 10.1159/000115141. [DOI] [PubMed] [Google Scholar]
  31. Tokola R. A., Anttila V. J., Neuvonen P. J. The effect of metoclopramide on the absorption of tolfenamic acid. Int J Clin Pharmacol Ther Toxicol. 1982 Oct;20(10):465–468. [PubMed] [Google Scholar]
  32. Tokola R. A., Kangasniemi P., Neuvonen P. J., Tokola O. Tolfenamic acid, metoclopramide, caffeine and their combinations in the treatment of migraine attacks. Cephalalgia. 1984 Dec;4(4):253–263. doi: 10.1046/j.1468-2982.1984.0404253.x. [DOI] [PubMed] [Google Scholar]
  33. Tokola R. A., Neuvonen P. J. Effects of migraine attack and metoclopramide on the absorption of tolfenamic acid. Br J Clin Pharmacol. 1984 Jan;17(1):67–75. doi: 10.1111/j.1365-2125.1984.tb05001.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Tokola R. A. The effect of metoclopramide and prochlorperazine on the absorption of effervescent paracetamol in migraine. Cephalalgia. 1988 Sep;8(3):139–147. doi: 10.1046/j.1468-2982.1988.0803113.x. [DOI] [PubMed] [Google Scholar]

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