1 When they looked at their ED records for administered medications, see more Sheftell et al also reported a link between low recurrence and pain-free response with naratriptan PO.46 Overall, it seems reasonable that a concerted effort should be made to discharge patients from the ED pain free. Parenterally administered dopamine antagonists are not only effective anti-emetics but also can reduce or terminate migraine headache. As a class, however, they frequently cause side effects (including sedation,
akathisia, and dystonia) that can outlast the symptoms of the migraine itself and thereby prolong patients’ functional disability. There is a need to pre-dose patients receiving phenothiazines (especially chlorpromazine) with IV fluid to prevent postural hypotension, as well as with a drug possessing anticholinergic properties to reduce the likelihood of extrapyramidal side effects. Droperidol and haloperidol are not recommended selleck as first-line therapy because of potential QTc prolongation and the consequent need for electrocardiogram monitoring. For a variety of reasons (discussed in some detail earlier in this paper), opiates/opioids generally are not recommended as first-line treatment for migraine. One argument used in support
of using opioids for first-line treatment is that they are quick to administer and act rapidly, such that patients can be discharged in a timely fashion. It remains unclear, however, whether the use of opioids does indeed save time. Coleman et al assessed migraine treatment patterns in 5 linked Canadian EDs.47 Opiates/opioids were
used as first-line MCE公司 treatment for 59.6% of the migraine patients. The odds of receiving an opioid as first-line therapy was increased in patients who took medications prior to ED admission and was decreased in patients who had a longer-lasting headache or a more urgent triage score. Those who received opioids first line spent less total time in the ED (177 minutes vs 237 minutes, P < .001). This contrasts with the findings of Tornabene et al, who found that patients who received opioids spent more time in their ED than patients who did not (160 minutes vs 125 minutes, P = .015), regardless of whether they often sought treatment for headache in the ED.48 Sumatriptan SQ, a relatively migraine-specific medication, is as effective as droperidol and prochlorperazine in providing pain relief. When limited to patients with no contraindications, it is very well tolerated. Adverse events are generally limited to transient chest tightness, shoulder pain, and neck pain, all of which rarely outlast the migraine pain itself and require no treatment to resolve. An argument can be made for the use of fixed drug combinations to treat migraine.