Migraine treatment in er

  1. 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
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  2. 32 Comments

  3. by   christinabartonRN
    Benadryl, toradol, and dilaudid = migraine cocktail
  4. by   hherrn
    To the OP- 2 mg of Dilaudid for a headache? That should do it, the rest is window dressing.

    In one of my places, it totally ranges, provider to provider. At the other place, with young, newly educated docs, they use a lot less narcotics.
  5. by   CodeteamB
    No narcotics. Maxeran 10 mg, Toradol 30mg and a 1L bolus. Works like a charm.
  6. by   xX Goose Xx
    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.
  7. by   Christy1019
    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.
  8. by   BostonFNP
    I order decadron and toradol IM in the clinic to keep people out of the ED and it works most of the time
  9. by   dsherman
    Thanks
  10. by   MunoRN
    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.
  11. by   ADeks
    Usually Compazine 10mg, Benadryl 25 mg, Toradol 30/15mg, and NS 1L. They bust out the narcs if pain persists.
  12. by   Anna Flaxis
    Toradol, Compazine, Benadryl, and a 1L NS bolus.
  13. by   cheriedg
    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!!
  14. by   turnforthenurse
    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.

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