Emergent management of primary headache: A review of current literature

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Purpose of review The current article reviews recent data on treatment of acute headache patients in the acute care setting. Recent findings Intravenous fluid hydration, a common component of emergency department (ED) migraine therapy, does not improve pain outcomes and leads to longer ED lengths of stay. Therefore, intravenous fluids should be administered only to migraine patients with clinical evidence of dehydration. Similarly, intravenous ketamine has garnered interest as a treatment for acute pain but does not provide substantial relief to migraine patients. New studies on the serotonin (5-HT3; 5-hydroxytryptamine-3) antagonist granisetron, intranasal lidocaine, and high-flow oxygen have reported conflicting results for migraine patients. Finally, although experts recommend avoiding opioids in migraine treatment, opioid administration remains prevalent in the ED. A new study has demonstrated that patients who receive intravenous hydromorphone in the ED are much less likely to attain acute headache relief. Standardized headache protocols may decrease opioid use and provide significant pain relief for patients. Summary Recent data have clarified the role of opioids and ketamine in the ED (do not use!). The role of treatment protocols and intravenous fluids is still ill-defined. Subpopulations of migraine patients may benefit from high-flow oxygen and intranasal lidocaine.

Original languageEnglish (US)
Pages (from-to)286-290
Number of pages5
JournalCurrent Opinion in Neurology
Volume31
Issue number3
DOIs
StatePublished - Jun 1 2018

Fingerprint

Headache
Migraine Disorders
Hospital Emergency Service
Opioid Analgesics
Ketamine
Lidocaine
Hydromorphone
Granisetron
Oxygen
Pain
Serotonin Antagonists
Acute Pain
Therapeutics
Clinical Protocols
Dehydration
Length of Stay
Serotonin

Keywords

  • emergency
  • headache
  • migraine
  • treatment

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Emergent management of primary headache : A review of current literature. / Naeem, Farnia; Schramm, Chris; Friedman, Benjamin W.

In: Current Opinion in Neurology, Vol. 31, No. 3, 01.06.2018, p. 286-290.

Research output: Contribution to journalReview article

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