What a headache: Updates on Migraine Management

Migraine headaches are not a benign disease – they have a significant impact on quality of life, ability to function, and pose a considerable economic and societal burden. Prevalence tends to peak during peoples’ period of highest productivity.  According to the World Health Organization’s (WHO) update on Global Burden of Disease (2004), a severe migraine is considered to be as disabling […]

Novel Migraine Therapies!

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, […]

Canadian Headache Society systematic review and recommendations on the treatment of migraine pain in emergency settings

Journal Club Summary Methodology Score: 3.5/5                 Usefulness Score: 4/5   Orr SL, et al. Cephalalgia. 2014 May 29. http://www.ncbi.nlm.nih.gov/pubmed/24875925   This Canadian Headache Society guideline for ED management of acute migraine gave a strong recommendation for 5 treatments: ketorolac, metoclopramide, sumatriptan (if presenting within 2 hours), prochlorperazine and lysine-ASA (the latter 2 are unavailable in Canada). Despite some concerns about lack of […]

Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence

Journal Club Summary Landmark Article Series Methodology Score: 4.5/5  Usefulness Score: 4.5/5 Colman I, Friedman BW, Brown MD, Innes GD, Grafstein E, Roberts TE, Rowe BH. BMJ. 2008 Jun 14;336(7657):1359-61 Article Link    ​In this well performed meta-analysis, a single dose of 10mg IV Dexamethasone administered before discharge demonstrated an important reduction in migraine recurrence rates (RR 0.74, 95% CI […]