Template:Non-specific headache treatment: Difference between revisions
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* [[Ketorolac]] 30 mg IV | * [[Ketorolac]] 30 mg IV | ||
**Lower doses are shown to be just as effective<ref>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.</ref> | **Lower doses are shown to be just as effective<ref>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.</ref> | ||
*Consider [[dexamethasone]] 10 mg IV single dose to prevent recurrence 48-72 hrs post-ED discharge, if history of recurrent headaches | *Consider [[dexamethasone]] 10 mg IV single dose to prevent recurrence 48-72 hrs post-ED discharge, if history of recurrent headaches<ref>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</ref> | ||
*[[Opioid]] medications if necessary | *[[Opioid]] medications if necessary | ||
*Consider 5-10 mg PO [[olanzapine]] (Zyprexa, Zydis) for prochlorperazine allergy<ref>Silberstein SD et al. Olanzapine in the treatment of refractory migraine and chronic daily headache. Headache. 2002 Jun;42(6):515-8.</ref><ref>Rozen TD. Olanzapine as an abortive agent for cluster headache. Headache. 2001;41(8):813-816.</ref> | *Consider 5-10 mg PO [[olanzapine]] (Zyprexa, Zydis) for prochlorperazine allergy<ref>Silberstein SD et al. Olanzapine in the treatment of refractory migraine and chronic daily headache. Headache. 2002 Jun;42(6):515-8.</ref><ref>Rozen TD. Olanzapine as an abortive agent for cluster headache. Headache. 2001;41(8):813-816.</ref> | ||
Revision as of 17:17, 2 July 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 5-10 mg PO olanzapine (Zyprexa, Zydis) for prochlorperazine allergy[5][6]
- 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[7]
- ↑ 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
- ↑ 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/