Template:Non-specific headache treatment: Difference between revisions
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**Particularly useful in psych patients with mania, BPD, psychosis | **Particularly useful in psych patients with mania, BPD, psychosis | ||
**IV olanzapine may be as safe or safer than IM, with faster onset<ref>Farkas J. PulmCrit. PulmCrit- Intravenous olanzapine: Faster than IM olanzapine, safer than IV haloperidol? Feb 1, 2016. http://emcrit.org/pulmcrit/intravenous-olanzapine-haloperidol/</ref> | **IV olanzapine may be as safe or safer than IM, with faster onset<ref>Farkas J. PulmCrit. PulmCrit- Intravenous olanzapine: Faster than IM olanzapine, safer than IV haloperidol? Feb 1, 2016. http://emcrit.org/pulmcrit/intravenous-olanzapine-haloperidol/</ref> | ||
====Other 2nd and 3rd Line Medications==== | |||
*Magnesium 1 g IV over 30-60 minutes, low side effect profile, in treatment of acute migraine attacks<ref>Demirkaya S et al. Efficacy of intravenous magnesium sulfate in the treatment of acute migraine attacks. Headache. 2001 Feb;41(2):171-7.</ref> | |||
Revision as of 02:29, 9 December 2016
Non-specific Headache
Treat specific headache type, if known
- 1st line: prochlorperazine (compazine) 10 mg IV (+/- diphenhydramine 25-50 mg IV) + 1 L normal saline IV bolus
- Place prochlorperazine in IV bag to reduce chances of side effects from rapid administration
- Alternative metoclopramide 10 mg IV[1] (diphenhydramine addition shows no clinical benifit[2])
- Ketorolac 30 mg IV
- Lower doses are shown to be just as effective[3]
- Consider dexamethasone 10 mg IV single dose to prevent recurrence 48-72 hrs post-ED discharge, if history of recurrent headaches[4]
- Opioid medications if necessary
- Consider haloperidol IV 5 mg in IVF bolus with diphenhydramine to prevent need for rescue medications[5]
- Consider 5-10 mg PO olanzapine (Zyprexa, Zydis) for prochlorperazine allergy[6][7]
- While less extrapyramidal symptoms than typical antipsychotics, beware QT prolongation
- Particularly useful in psych patients with mania, BPD, psychosis
- IV olanzapine may be as safe or safer than IM, with faster onset[8]
Other 2nd and 3rd Line Medications
- Magnesium 1 g IV over 30-60 minutes, low side effect profile, in treatment of acute migraine attacks[9]
- ↑ Metoclopramide for Pain and Nausea in Patients with Migraine. Am Fam Physician. 2005 May 1;71(9):1770.
- ↑ Friedman BW, et al. Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department-Based Randomized Clinical Trial. Annals of EM. January 2016. 67(1):32-39.
- ↑ Brown CR, Moodie JE, Wild VM, Bynum LJ. Comparison of intravenous ketorolac tromethamine and morphine sulfate in the treatment of postoperative pain. Pharmacotherapy. 1990;10(6Patient 2):116S-121S.
- ↑ Colman et al Paraenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ 2008 Jun.;336(7657):1359–1361
- ↑ Gaffigan ME et al. A Randomized Controlled Trial of Intravenous Haloperidol vs. Intravenous Metoclopramide for Acute Migraine Therapy in the Emergency Department. J Emerg Med. 2015 Sep;49(3):326-34.
- ↑ Silberstein SD et al. Olanzapine in the treatment of refractory migraine and chronic daily headache. Headache. 2002 Jun;42(6):515-8.
- ↑ Rozen TD. Olanzapine as an abortive agent for cluster headache. Headache. 2001;41(8):813-816.
- ↑ Farkas J. PulmCrit. PulmCrit- Intravenous olanzapine: Faster than IM olanzapine, safer than IV haloperidol? Feb 1, 2016. http://emcrit.org/pulmcrit/intravenous-olanzapine-haloperidol/
- ↑ Demirkaya S et al. Efficacy of intravenous magnesium sulfate in the treatment of acute migraine attacks. Headache. 2001 Feb;41(2):171-7.