Migraine treatment in er

[dsherman]

I am wondering what your er does as far as migraine treatment. We use reglan 10 mg IVP benadryl 12.5 mg IVP dexamethasone 4 mg IVP or Solu medrol 125, morphine 6 mg IVP or Dilaudid 2 mg IVp

[turnforthenurse, MSN, NP]

We don't give narcs for migraines. The order set depends on the doc, but typically 12.5-25mg Benadryl, 5mg Reglan or 4mg Zofran, Toradol 15-30mg, magnesium and 1L bolus. One of our newer docs like to order Compazine.

[Racer15, BSN, RN]

Usually Benadryl 12.5, phenergan 12.5, decadron 10, and toradol 30.

[Altra, BSN, RN]

Narcotics as a first-line treatment for migraines, OP?

Interesting.

[twss2323]

This is slightly off topic, but I'm a nursing student and stumbled across this thread... And I'm curious, what does the Benadryl do? I've never heard of that as a treatment (but I'm a fairly new student).

[Christy1019, ASN, RN]

Narcotics as a first-line treatment for migraines, OP?

Interesting.

I agree, I can't believe how liberal some places are with the dilaudid for migraines!

[morte, LPN, LVN]

This is slightly off topic, but I'm a nursing student and stumbled across this thread... And I'm curious, what does the Benadryl do? I've never heard of that as a treatment (but I'm a fairly new student).

Diphenhydramine for Acute Migraine - Full Text View - ClinicalTrials.gov

apparently, it is not known if/why it does anything.!

[dsherman]

BEnadryl help with nausea and if reglan or compazine are given it helps with the side effect in which the patient feels like they are crawling out of their skin

[CodeteamB]

Yeah, the Benadryl (at least at my place of work) is ordered very rarely, as if you give your metoclopramide at a reasonable rate you don't really need it, and we are very careful to make sure all new staff know to run it slowly. The Maxeran itself is often enough to cease the headache.

[twss2323]

Thanks for the feedback... Interesting...

[IrishErin]

We also give Toradol, Maxeran, Benadryl and 500mL to 1L saline bolus.

A few patients have care plans from their family doctors that state they may have gravol/morphine up to a few times a month, and one that comes in for IM Demerol.

[1fastRN]

Toradol + Reglan (diluted)

Sometimes benadryl if they're anxious to begin with but usually just the two. Sometimes we'll give PO Fiorcet

[mish_RN]

25-50 of Benadryl, 10 of Reglan, 1 L NS bolus, and a dark room/side of the curtain. Sometimes given with 10 of Decadron and some O2. Never any narcs for migraines. Causes that rebound pain, one MD said.