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Not necessarily in the ER, but I will give 30 mg IV Toradol and 10 mg IV Compazine along with some fluids. If patient is older than 60, I will drop Toradol to 15 mg. Works great and I can avoid the narcs.
I've worked with many neurosurgeons who stated it did more harm than good to give narcotics with migraines because of refractory pain that can be worse, after the narcotic wears off.
Both EDs I've worked in have used combinations of toradol, reglan, compazine, benadryl, decadron, zofran and IV fluids. Works well in my experience.
Usually toradol and/or a triptan, sometimes with naproxen added as well. None of our ER docs order opiates anymore for migraines except in very rare circumstances due the the rebound effect. We have a few patients who only require IV magnesium when the come to the ER.
No NARCS! From a migraine suffer.....for a good deal of us it does cause refractory migraines that really are way worse than original. What would be nice from a holistic standpoint.... Lights dim, quiet environment, cold washcloths to neck, head and head/ hand massage as distractor would make you the superhero nurse!!
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.