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A Neurologist’s Guide to Acute Migraine Therapy in the Emergency Room

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A Neurologist’s Guide to Acute Migraine Therapy in the Emergency Room

Neurologists face a unique challenge in the Emergency Room (ER), as many migraine sufferers seek relief from their symptoms. With estimates that 1.2 million visits to an ER occur annually across America, doctors must strive to provide effective care for these patients.

The aim of acute treatment is to reduce attack frequency and duration, thus relieving pain intensity and the likelihood of further attacks. This is an integral element of the stepped care approach (see Step 4). In certain circumstances, preventive therapy may be indicated depending on a patient’s migraine frequency, severity of their attacks and how it impacts quality of life (see Table 4).

All those experiencing an ictus should be offered acute medication to alleviate their headache. However, frequent use of acute medications has been linked to an increased risk of migraine-overuse headache (MOH), so it’s essential that patients understand that only one dose should be used per attack and other non-oral alternatives such as IV, IN, nasal spray or suppository are also recommended.

Other methods for pain relief involve injecting lidocaine or bupivacaine into the back of your neck at the bottom of the skull, which blocks pain signals from reaching your nerves and provides temporary numbing effects. However, these treatments should only be used temporarily and not as a long-term solution to migraine headaches.

Avoid giving narcotics, barbiturates or opioids during an attack for this same reason; these can increase your risk of dependency. Other possible treatments include oral ergot alkaloids and prokinetic antiemetics which should only be used rarely to relieve nausea and vomiting.

Based on the patient’s pain severity, a neurologist may prescribe medication for them to take at home. This could include acetaminophen, nonsteroidal anti-inflammatory drugs or both for pain relief.

Treating severe migraine attacks in the emergency room is more challenging than treating milder ones, so it’s essential to know which treatment works best for each type of headache and pain level. Additionally, bring a list of your medications along with notes about any side effects that may arise.

Before finding the medication or combination that works for you, you may need to visit the emergency room multiple times. It’s also essential that you get a medical ID bracelet or card which alerts emergency workers about your migraine diagnosis so they can provide assistance.

The emergency room doctor will examine your head and take vital signs to rule out any other conditions causing your severe headaches or other issues. They also administer medicine via IV to reduce symptoms and hydrate you.

Your neurologist will assess your medical history to identify the most suitable medications, and they are often experts in this area and on-the-frontline of any new research regarding migraine treatments. They provide personalized attention and expertise that other healthcare professionals may not offer.

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