tag:blogger.com,1999:blog-2186593343917545414.post3339178312458314522..comments2024-03-10T12:29:30.004-07:00Comments on pediatric neurology: Management of acute migraine in the emergency departmentGalen Breningstall, MDhttp://www.blogger.com/profile/07170864203251456228noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-2186593343917545414.post-27493108776468192492016-06-22T12:07:16.587-07:002016-06-22T12:07:16.587-07:00Emergency physicians should use any of three drugs...Emergency physicians should use any of three drugs as first-line treatments for migraine in the emergency department (ED), according to a new guideline.<br /><br />A literature review found evidence of efficacy and safety for intravenous metoclopramide, intravenous prochlorperazine, and subcutaneous sumatriptan to treat these patients' headache pain, prompting a Level B recommendation, Mia Minen, MD, of NYU Langone Medical Center in New York City, and colleagues reported online in Headache.<br /><br />However, opioids -- injectable morphine and hydromorphone -- should be avoided, they said…<br /><br />Although no medications received a Level-A "must offer" recommendation, the three aforementioned drugs received a Level-B "should offer" recommendation, based on class 1 evidence, the researchers said.<br /><br />The corticosteroid dexamethasone received the same level recommendation to be given to patients in order to prevent migraine recurrence, they reported.<br /><br />Other drugs with a Level-C "offer" recommendation included acetaminophen, acetylsalicylic acid, chlorpromazine, dexketoprofen, diclofenac, dipyrone, droperidol, haloperidol, ketorolac, and valproate.<br /><br />In addition to avoiding the opioids for migraine treatment in the ED, the researchers also advised passing on diphenhydramine, lidocaine, and octreotide…<br /><br />Stephen Silberstein, MD, of the Jefferson Headache Center in Philadelphia, noted in an accompanying editorial that the "fundamental problem of guidelines that want to comment on old drugs [is that] there are few, if any, studies. The old maxim applies: lack of evidence does not mean lack of efficacy."<br /><br />"What we need is more controlled trials of medications in the borderland of uncertainty and more studies in personalized medicine," Silberstein wrote.<br /><br />http://www.medpagetoday.com/Neurology/Migraines/58578Galen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.com