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Headache-Migraine

Date Last Search Run: Feb 01, 2022
Table last updated: Sep 29, 2022
Data last added: Sep 10, 2022

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)    
2 (fair evidence exists)    
3 (weak evidence exists)    


Interventions

Acetaminophen IV
Level Direction Primary Outcome Patient/Process Setting Reference
I Neutral (Yellow) Visual analogue scores at 15 and 30 minutes Patient ED-MD Turkcuer I., Serinken M., Eken C., et al. Intravenous paracetamol versus dexketoprofen in acute migraine attack in the emergency department: A randomised clinical trial. Emerg Med 2014; 31(3):182-185. Medline
II Supportive (Green) Change in severity of headache using NRS Patient ED-MD Friedman BW., Solorzano C., Esses D., et al. Treating headache recurrence after emergency department discharge: A randomized controlled trial of naproxen versus sumatriptan. Ann Emerg Med 2010; 56(1):7-17. Medline

Fluid Bolus
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Pain relief Patient ED-MD Balbin JE, Nerenberg R, Baratloo A, Friedman BW. Intravenous fluids for migraine: a post hoc analysis of clinical trial data. Am J Emerg Med 2016; 34(4) 713-6. Medline
II Neutral (Yellow) Anagesia Patient ED-MD Patniyot IR, Gelfand AA. Acute Treatment Therapies for Pediatric Migraine: A Qualitative Systematic Review. Headache 2016; 56(1) 49-70. Medline

Ketamine
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Improvement in pain at 30 min Patient ED-MD Benish T, Villalobos D, Love S, Casmaer M, Hunter CJ, Summers SM, et al. The THINK (Treatment of Headache with Intranasal Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine with Intravenous Metoclopramide. J Emerg Med 2019; 56(3) 248-57. Medline
I Neutral (Yellow) Difference in NRS score reduction from baseline to 30 minutes Patient ED-MD Etchison AR, Bos L, Ray M, McAllister KB, Mohammed M, Park B, et al. Low-dose Ketamine Does Not Improve Migraine in the Emergency Department A Randomized Placebo-controlled Trial. The western J of emergency medicine 2018; 19(6) 952-60. Medline

Metoclopramide
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Effectiveness of pain relief Patient ED-MD Barleycorn D. Systematic review: Is Metoclopramide more effective than Sumatriptan in relieving pain from migraine in adults in the Emergency Department (ED) setting? Int Emerg N 2016; 27 51-5. Medline
I Supportive (Green) Improvement on VAS Patient ED-MD Eken C. Critical reappraisal of intravenous metoclopramide in migraine attack: A systematic review and meta-analysis. Am J Emerg Med 2015; 33(3):331-7. Medline
I Supportive (Green) Pain response Patient ED-MD Orr SL., Aube M., Becker WJ., et al. Canadian headache society systematic review and recommendations on the treatment of migraine pain in emergency settings. Cephalalgia 2015; 35(3):271-84. Medline
I Supportive (Green) Decrease in pain at 60 minutes Patient ED-MD Soltani KM, Motamed H, Eslami K, Majdinasab N, Kouti L. Randomised trial of IV metoclopramide vs IV ketorolac in treatment of acute primary headaches. Am J Emerg Med 2021; 50:376–80. Medline
II Supportive (Green) Headache reduction. Patient ED-MD Patniyot IR, Gelfand AA. Acute Treatment Therapies for Pediatric Migraine: A Qualitative Systematic Review. Headache 2016; 56(1) 49-70. Medline
II Neutral (Yellow) ED revisit within 3 days Process ED-MD Bachur RG., Monuteaux MC., Neuman MI. A comparison of acute treatment regimens for migraine in the emergency department. Pediatrics 2015; 135(2):232-8. Medline

Metoclopramide plus diphenhydramine
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Improvement in pain at 30 minutes Patient ED-MD Benish T, Villalobos D, Love S, Casmaer M, Hunter CJ, Summers SM, et al. The THINK (Treatment of Headache with Intranasal Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine with Intravenous Metoclopramide. J Emerg Med 2019; 56(3) 248-57. Medline
I Supportive (Green) Headache pain improvement Patient ED-MD Friedman BW, Irizarry E, Cain D, Caradonna A, Minen MT, Solorzano C, Zias E, Zybert D, McGregor M, Bijur PE, Gallegher EJ. Randomized Study of Metoclopramide Plus Diphenhydramine for Acute Posttraumatic Headache. Neurology 2021; 96(18):e2323–31. Medline
I Neutral (Yellow) Headache relief within 2 hours - sustained for 48 Patient ED-MD Friedman BW, Cabral L, Adewunmi V, Solorzano C, Esses D, Bijur PE, et al. Diphenhydramine as Adjuvant Therapy for Acute Migraine An Emergency Department-Based Randomized Clinical Trial. Ann Emerg Med 2016; 67(1) 32-9.e3. Medline
II Supportive (Green) Sustained headache relief for 48 hours. Patient ED-MD Friedman BW, Babbush K, Irizarry E, White D, John Gallagher E. An exploratory study of IV metoclopramide+diphenhydramine for acute post-traumatic headache. Am J Emerg Med 2018; 36(2) 285-9. Medline

Nitrous Oxide
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Pain scores Patient ED-MD Triner WR., Bartfield JM., Birdwell M., Raccio-Robak N. Nitrous oxide for the treatment of acute migraine headache. Am J Emerg Med 1999; 17(3):252-254. Medline

NSAIDs
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Analgesic efficacy Process ED-MD Motov S, Yasavolian M, Likourezos A, Pushkar I, Hossain R, Drapkin J, et al. Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department A Randomized Controlled Trial. Ann Emerg Med 2017; 70(2) 177-84. Medline
I Supportive (Green) Pain response Patient ED-MD Orr SL., Aube M., Becker WJ., et al. Canadian headache society systematic review and recommendations on the treatment of migraine pain in emergency settings. Cephalalgia 2015; 35(3):271-84. Medline
I Supportive (Green) Visual analogue scores at 15 and 30 minutes Patient ED-MD Turkcuer I., Serinken M., Eken C., et al. Intravenous paracetamol versus dexketoprofen in acute migraine attack in the emergency department: A randomised clinical trial. Emerg Med 2014; 31(3):182-185. Medline
I Neutral (Yellow) Improvement in NRS (Numerical Rating Scale) of pain following treatment. Patient ED-MD Dogruyol S, Gur STA, Akbas I, Kocak MB, Kocak AO, Ceylan M, Tekyol D. Intravenous ibuprofen versus sodium valproate in acute migraine attacks in the emergency department: A randomized clinical trial. Am J Emerg Med 2022; 55:126–32. Medline
I Neutral (Yellow) Analgesic efficacy Patient ED-MD Harden RN., Gracely RH., Carter T., Warner G. The placebo effect in acute headache management: Ketorolac, meperidine, and saline in the emergency department. Headache 1996; 36(6):352-6. Medline
III Supportive (Green) Pain reduction Patient ED-MD Davis CP., Torre PR., Schafer NC., Dave B., Bass B. Jr. Ketorolac as a rapid and effective treatment of migraine headache: Evaluations by patients. Am J Emerg Med 1993; 11(6):573-5. Medline
III Neutral (Yellow) Pain control. Patient ED-MD Patniyot IR, Gelfand AA. Acute Treatment Therapies for Pediatric Migraine: A Qualitative Systematic Review. Headache 2016; 56(1) 49-70. Medline

Opioid
Level Direction Primary Outcome Patient/Process Setting Reference
III Opposes (Red) Length of stay Process ED-MD Young N, Silverman D, Bradford H, Finkelstein J. Multicenter prevalence of opioid medication use as abortive therapy in the ED treatment of migraine headaches. Am J Emerg Med 2017; 35(12) 1845-9. Medline

Oxygen
Level Direction Primary Outcome Patient/Process Setting Reference
I Neutral (Yellow) Pain scores Patient ED-MD Triner WR., Bartfield JM., Birdwell M., Raccio-Robak N. Nitrous oxide for the treatment of acute migraine headache. Am J Emerg Med 1999; 17(3):252-254. Medline


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