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Acute Migraine in the ED / Inpatient

Registrar quick reference · AHS 2025 ED parenteral guideline · companion to the outpatient sheet
Compiled Jun 2026
Verify doses locally
Exclude secondary first
Decision support only — for the patient who presents acutely (often vomiting, dehydrated, or in status migrainosus >72h) and has failed their usual oral treatment. Outpatient choice of regimen, prevention, and medication-overuse limits live on the community sheet. Two rules dominate here: exclude secondary headache, and don't reach for opioids. Verify all doses.
1 Parenteral treatment — what the evidence supports
First-linestart together
Acute attack needing parenteral therapy.
IV prochlorperazine must offer or metoclopramide, + greater occipital nerve block must offer. Add IV ketorolac/dexketoprofen and/or SC sumatriptan; IV fluids. Co-give an antihistamine to cover akathisia.
Refractory / status>72h or no response
Not settling on first-line.
Dihydroergotamine (severe/status), IV valproate, or IV magnesium (most useful with aura). Involve neurology; consider admission.
Before dischargestop the bounce-back
Responding, planning discharge.
IV dexamethasone — reduces 24–72h recurrence Colman BMJ (give as well as, not instead of, an abortive). Arrange follow-up; flag overuse for the outpatient plan.
Opioids (incl. hydromorphone) must not be offered — Level A against: poor efficacy, more recurrence, return visits, and dependence. Anti-dopaminergics work as migraine treatments in their own right, not just as antiemetics — but watch for akathisia/dystonia (higher with prochlorperazine than metoclopramide) and QT prolongation.
2 Exclude secondary headache first

Red flags — don't anchor on migraine

  • OnsetThunderclap (peak <1 min), "first or worst," or a clear change from the usual pattern.
  • SignsFever/meningism, focal deficit, papilloedema, reduced GCS, new seizure.
  • ContextNew onset >50, immunocompromised/cancer, pregnancy or postpartum, positional or Valsalva-triggered.

The work-up it points to

  • SAHNon-contrast CT; if >6h from onset or CT negative with ongoing suspicion → LP (xanthochromia) ± CTA.
  • CVSTPregnancy/postpartum, prothrombotic, or papilloedema → CT/MR venogram.
  • GCAAge >50, jaw claudication, scalp tenderness → ESR/CRP, start steroid, refer.
  • OtherMeningitis → LP; pregnancy + ↑BP → pre-eclampsia/PRES; sudden + endocrine → pituitary apoplexy.
3 Agents, doses & the cautions

Doses (verify locally)

  • Prochlorperazine10 mg IV
  • Metoclopramide10–20 mg IV
  • Ketorolac10–30 mg IV/IM
  • Sumatriptan6 mg SC
  • Dexamethasone~10 mg IV (recurrence)
  • Magnesium1–2 g IV
  • Valproate~1 g IV

Cautions & disposition

  • AkathisiaCo-give diphenhydramine with anti-dopaminergics (esp. prochlorperazine); watch dystonia & QTc.
  • SpacingNo triptan + ergot/DHE within 24h of each other (vasospasm). DHE: avoid in CAD, uncontrolled HTN, pregnancy.
  • PregnancyAvoid valproate & DHE; paracetamol, antiemetics, magnesium, GONB are the safer tools.
  • Admit ifIntractable status, persistent vomiting/dehydration, or diagnostic uncertainty.
Sources. Robblee et al. "2025 guideline update to acute treatment of migraine for adults in the emergency department: AHS evidence assessment of parenteral pharmacotherapies," Headache 2025 (prochlorperazine IV & GONB must-offer; metoclopramide/ketorolac/dexketoprofen/SC sumatriptan should-offer; chlorpromazine/dexamethasone/valproate may-offer; hydromorphone must-not-offer). Canadian Headache Society ED recommendations. eTG.   Key evidence: Colman et al, BMJ 2008 (parenteral dexamethasone reduces early migraine recurrence); AHS/AHRQ parenteral comparative-effectiveness reviews.   Caveats: dihydroergotamine and IV magnesium carry weaker/mixed evidence (level U in 2016) but remain options for refractory/status and aura respectively. Akathisia risk is higher with prochlorperazine than metoclopramide. Outpatient regimen choice, prevention, and overuse limits are on the companion community sheet. Verify all doses and contraindications.