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

[christinabartonRN]

Benadryl, toradol, and dilaudid = migraine cocktail

[Guest219794]

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.

[CodeteamB]

No narcotics. Maxeran 10 mg, Toradol 30mg and a 1L bolus. Works like a charm.

[Goose Xx, MSN, RN, EMT-P, CRNA]

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.

[Christy1019, ASN, RN]

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.

[BostonFNP, APRN]

I order decadron and toradol IM in the clinic to keep people out of the ED and it works most of the time

[dsherman]

Thanks

[MunoRN, RN]

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.

[ADeks]

Usually Compazine 10mg, Benadryl 25 mg, Toradol 30/15mg, and NS 1L. They bust out the narcs if pain persists.

[Anna Flaxis, BSN, RN]

Toradol, Compazine, Benadryl, and a 1L NS bolus.

[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!!