Management of Primary Headache in the Emergency Department and Inpatient Headache Unit

Kabbouche, Marielle A.; Khoury, Chaouki K.

doi:10.1016/j.spen.2015.08.004

Cited by 5 publications

(5 citation statements)

References 30 publications

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“…12,14,15,[18][19][20][21][22][23][25][26][27][28]30,31,35,36,[44][45][46] Most studies assess single-dose regimens; however, evidence exists suggesting benefit for daily dosing over 5-7 days. 14,48 No interactions have been observed between other headache pharmacologic agents, including NSAIDs, triptans, DHE, valproic acid, and caffeine. 47 Efficacy is not contingent on baseline serum magnesium levels; 27 however, patients with lower baseline magnesium levels may have greater improvement and complete resolution of symptoms compared to patients with higher baseline magnesium levels.…”

Section: Discussionmentioning

confidence: 99%

“…47 Efficacy is not contingent on baseline serum magnesium levels; 27 however, patients with lower baseline magnesium levels may have greater improvement and complete resolution of symptoms compared to patients with higher baseline magnesium levels. 14,48 No interactions have been observed between other headache pharmacologic agents, including NSAIDs, triptans, DHE, valproic acid, and caffeine. Magnesium may enhance the CNS depressive effects of drugs including haloperidol and prochlorperazine.…”

Section: Discussionmentioning

confidence: 99%

“…50,51 Magnesium is reported as generally well tolerated when used for headache and migraine pain. 12,14,48 Adverse effects to monitor for include hypotension and flushing. 44,50 AUTHORS CONCLUSIONS Implications for Practice.-While we cannot draw a firm conclusion on the efficacy or benefit of intravenous magnesium sulfate in the treatment of acute nontraumatic headaches, the existing evidence indicated potential benefits in pain control intensity beyond 1 hour, aura duration, and need for rescue analgesia.…”

Section: Discussionmentioning

confidence: 99%

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Intravenous Magnesium Sulfate to Treat Acute Headaches in the Emergency Department: A Systematic Review

et al. 2019

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Introduction Non‐traumatic headaches comprise up to 4% of all emergency department (ED) visits. Current practice is moving toward multimodal analgesia regimens that limit narcotic use. Objective The objective of this systematic review is to address the following research question: In patients with non‐traumatic headaches (Population), does administration of intravenous magnesium sulfate (Intervention) compared to placebo, corticosteroids, dopamine antagonists, ergot alkaloids, non‐steroidal anti‐inflammatory drugs (NSAIDs), triptans, or usual care result in better pain control, lower rate of recurrence at 24 hours, lower requirements for rescue analgesia, and less adverse medication effects (Outcomes)? Methods Scholarly databases and relevant bibliographies were searched, as were clinical trial registries and relevant conference proceedings to limit publication bias. Studies were not limited by date, language, or publication status. Inclusion criteria were: (1) randomized clinical trial (RCT), (2) patients age ≥18 years, (3) non‐traumatic headache, (4) patients treated in ED or an outpatient acute care treatment center, and (5) magnesium sulfate administered intravenously (IV). Eligible comparison groups included: placebo, conventional therapy, dopamine antagonist, NSAID, corticosteroid, ergot alkaloid, or triptans. Results Out of 4018 identified references, 7 RCTs (545 participants) that treated migraine headaches (n = 6) and benign non‐traumatic headaches (n = 1) met inclusion criteria. Pain intensity was improved with magnesium sulfate vs comparators at 60‐120 minutes, but not at earlier time points. Result for the endpoint of pain reduction by 50% were conflicting as 3 studies reported that headache was improved, unchanged, and less with magnesium sulfate. Complete pain relief was improved with magnesium sulfate in 1 study, and in the migraine with aura (MA) subgroup in another. The need for rescue analgesia at any point was improved with magnesium sulfate in 1 study, and in the MA subgroup in another. Twenty‐four‐hour headache recurrence was improved with magnesium sulfate in 1 study, but unchanged in a second. The intended meta‐analysis was not performed due to the clinical heterogeneity among studies. Conclusion While we cannot draw a firm conclusion on the efficacy or benefit of intravenous magnesium sulfate in the treatment of acute non‐traumatic headaches, the existing evidence indicates potential benefits in pain control beyond 1 hour, aura duration, and need for rescue analgesia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Intravenous Magnesium Sulfate to Treat Acute Headaches in the Emergency Department: A Systematic Review

et al. 2019

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“…61 IV infusion of DHE 1 mg/8 hours for 1-3 days in the hospital setting has a very high response rate for refractory migraine patients: 97% pain reduction, 60-78% pain freedom. 62,63 However, IV DHE, because of its high peak plasma concentration (C max ), has more systemic side effects than other formulations. 43,44,64 Despite these drawbacks it remains a popular choice in specialist Headache centers.…”

Section: Dhe 45 ®mentioning

confidence: 99%

Dihydroergotamine (DHE) – Then and Now: A Narrative Review

2019

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Objective.-To provide a narrative review of clinical development programs for non-oral, non-injectable formulations of dihydroergotamine (DHE) for the treatment of migraine.Background.-Dihydroergotamine was one of the first "synthetic drugs" developed in the 20th century for treating migraine. It is effective and recommended for acute migraine treatment. Since oral DHE is extensively metabolized, it must be given by a non-oral route. Intravenous DHE requires healthcare personnel to administer, subcutaneous/intramuscular injection is challenging to self-administer, and the approved nasal spray formulation exhibits low bioavailability and high variability that limits its efficacy. Currently there are several attempts underway to develop non-oral, non-injected formulations of DHE.Method.-A systematic search of MEDLINE/PubMed and Clini calTr ials.gov databases, then narrative review of identified reports, focusing on those published in the last 10 years. Results.-Of 1881 references to DHE from a MEDLINE/PubMed search, 164 were from the last 10 years and were the focus of this review. Further cross reference was made to ClinicalTrials.gov for 19 clinical studies, of which some results have not yet been published, or are studies that are currently underway. Three nasal DHE products are in clinical development, reawakening interest in this route of delivery for migraine. Other routes of DHE administration have been, or are being, explored.Conclusion.-There is renewed appreciation for DHE and the need for non-oral, non-injected delivery is now being addressed.

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“…Injectable DHE has Level B evidence, with the best-known study published by Neil Raskin, 34 with his use of IV DHE every 8 hours over 3 days showing that 89% of patients treated with repetitive IV DHE achieved headache freedom in 48 hours 8 . Later studies have mimicked these results at inpatient units 35,36 …”

Section: Migraine-specific Treatmentmentioning

confidence: 99%

Acute Migraine Treatment

Ailani¹

2021

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEWMigraine is a disabling disease of attacks of moderate to severe pain with associated symptoms. Every person with migraine requires treatment for acute attacks. Treatments can range from behavioral management and nonspecific medications to migraine-specific medications and neuromodulation. For many with migraine, having a combination of tools allows for effective treatment of all types of attacks.RECENT FINDINGSOver the past several years, four neuromodulation devices have been cleared by the US Food and Drug Administration (FDA) for treatment of acute migraine, and three medications with novel mechanisms of action have been FDA approved. They add to the arsenal available to people with migraine and focus on migraine-specific pathways to allow for precise care with fewer side effects.SUMMARYThis article discusses acute migraine therapy, focusing on best-level evidence.

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Management of Primary Headache in the Emergency Department and Inpatient Headache Unit

Cited by 5 publications

References 30 publications

Intravenous Magnesium Sulfate to Treat Acute Headaches in the Emergency Department: A Systematic Review

Intravenous Magnesium Sulfate to Treat Acute Headaches in the Emergency Department: A Systematic Review

Dihydroergotamine (DHE) – Then and Now: A Narrative Review

Acute Migraine Treatment

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