ACUTE THERAPIES FOR SEVERE AND PROTRACTED MIGRAINES

     Mix 10 mg prochlorperazine with 1 mg dihydroergotamine in a syringe.  Slowly infuse ¾ of the solution

intravenously.  If after 10-15 minutes the headache persists, infuse the remainder of the solution intravenoulsy.  If needed, dihydroergotamine (0.5-1 mg) may be repeated in one hour if the headache persists.

     Sumatriptan (6 mg) subcutaneously.  Avoid usage if the patient has received ergotamine products within the past 24 hours.

     Ketorolac (30-60 mg) may be given intramuscularly or intravenously.  If nausea is a prominent symptom, prochlorperazine (10 mg) or metoclopramide (10 mg) can be given intramuscularly prior to the ketorolac.

     Mix chlorpromazine (1 ml which equals 25 mg) with 4 ml of crystalloid (1 ml of solution equals 5 mg chlopromazine) in a syringe.  Administer 1 ml of solution intravenously every 5-10 minutes until either the headache is relieved or the entire 5 ml of solution has been used.  Patients should be pretreated with intravenous hydration (250-500 ml of D₅1/2NS) and they should be kept for observation for several hours after therapy.

     A bolus of haloperidol (5 mg) may be given intravenously following a bolus of NS (500-1000 ml)

   Droperidol (1.25-2.5 mg) IV

     Administer methylprednisolone (250-500 mg) intravenously.

     Administer 1 gm magnesium sulfate in 100 ml D5W intravenously.  This therapy is more effective in patients with a low ionized magnesium level prior to therapy.

     Avoid narcotics in most cases.  In severe refractory cases administer prochlorperazine (10 mg) with demerol (75-100 mg) intravenously.

     Consider rehydration in all patients.  Also, when nausea is a prominent symptom, consider antiemetic therapy.