"For those of us who work in the Emergency Department, we are very well versed in migraine management. We see these patients frequently, and typically don't hesitate to utilize our typical maxeran/toradol/fluids combo, as it is typically very effective. But what if your first, second and even third line treatments are ineffective?
Prior to considering neurology consultation for further management, perhaps we should consider one of the more controversial and novel treatments, such as propofol or magnesium. How about migraine preventative therapy, what's the evidence behind dexamethasone in preventing recurrence? Here we seek to further delve into novel migraine therapies in the ED
- Propofol
- Magnesium
- Dexamethasone
Bottom Lines
- Propofol is cheap, effective and safe - more studies are required, but it is likely an effective treatment option for patients with refractory migraines.
- Magnesium is highly accessible, cheap, safe, easy to administer and appears to be highly efficacious for headache resolution.
- Dexamethasone has been demonstrated to significant reduce migraine recurrence following therapy, and we would recommend an single dose of 10 mg IV."