The emergency department management of migraine

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Abstract
Disabling migraine headache is an uncommon but important reason for presentation to emergency departments. Although not life‐threatening, migraine causes considerable distress for those affected. This article reviews the currently available parenteral agents used to treat this condition, comparing efficacy, the need for additional medication and the incidence of “rebound” headache.Ketorolac and lignocaine fail to reach acceptable efficacy standards and are not recommended for use in acute migraine. Metoclopramide and pethidine perform a little better but each has been shown to be inferior to other treatments.Dihydroergotamine is less effective than chlorpromazine and has a high rate of unpleasant side effects. Haloperidol needs to be studied in appropriate trials before conclusions can be drawn. The most effective agents seem to be chlorpromazine and sumatriptan, each of which has achieved greater than 70% efficacy in a number of studies. Prochlorperazine achieves this level in some studies but numbers are too small to be conclusive. Further research should concentrate on comparison of chlorpromazine, sumatriptan, prochlorperazine and haloperidol in order to clarify their relative effectiveness in the management of migraine.