Template:Non-specific headache treatment - Revision history

Danbot: Convert headache medications to MedicationDose templates for SMW integration

2026-03-20T22:34:24Z

Convert headache medications to MedicationDose templates for SMW integration

Zbuchwald: /* Non-specific Headache */

2024-10-11T12:44:25Z

Non-specific Headache

← Older revision		Revision as of 12:44, 11 October 2024
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	**OR 1-2 sprays IN (may repeat after 2 hours)		**OR 1-2 sprays IN (may repeat after 2 hours)
	**Contraindications to triptans include CV disease, uncontrolled [[HTN]], [[pregnancy]]		**Contraindications to triptans include CV disease, uncontrolled [[HTN]], [[pregnancy]]
	*[[Dexamethasone]] to prevent recurrence 48-72 hours post-ED discharge, if history of migraines and recurrent headaches<ref>Colman et al Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ 2008 Jun.;336(7657):1359–1361</ref>		*[[Dexamethasone]] to prevent recurrence 48-72 hours post-ED discharge, if history of migraines and/or recurrent headaches<ref>Colman et al Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ 2008 Jun.;336(7657):1359–1361</ref>
	** 10 mg IV single dose is commonly accepted regimen, 4 mg IV dose was shown to be as efficacious in a follow up study. <ref>Friedman BW, Solorzano C, Kessler BD, Martorello K, Lutz CL, Feliciano C, Adler N, Moss H, Cain D, Irizarry E. Randomized Trial Comparing Low- vs High-Dose IV Dexamethasone for Patients With Moderate to Severe Migraine. Neurology. 2023 Oct 3;101(14):e1448-e1454.</ref>		** 10 mg IV single dose is commonly accepted regimen, 4 mg IV dose was shown to be as efficacious in a follow up study. <ref>Friedman BW, Solorzano C, Kessler BD, Martorello K, Lutz CL, Feliciano C, Adler N, Moss H, Cain D, Irizarry E. Randomized Trial Comparing Low- vs High-Dose IV Dexamethasone for Patients With Moderate to Severe Migraine. Neurology. 2023 Oct 3;101(14):e1448-e1454.</ref>

Zbuchwald: /* Non-specific Headache */

2024-10-11T12:38:31Z

Non-specific Headache

← Older revision		Revision as of 12:38, 11 October 2024
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	**OR 1-2 sprays IN (may repeat after 2 hours)		**OR 1-2 sprays IN (may repeat after 2 hours)
	**Contraindications to triptans include CV disease, uncontrolled [[HTN]], [[pregnancy]]		**Contraindications to triptans include CV disease, uncontrolled [[HTN]], [[pregnancy]]
	*~~Consider~~ [[~~dexamethasone~~]] ~~10 mg IV single dose~~ to prevent recurrence 48-72 ~~hrs~~ post-ED discharge, if history of recurrent headaches<ref>Colman et al ~~Paraenteral~~ dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ 2008 Jun.;336(7657):1359–1361</ref>		*[[Dexamethasone]] to prevent recurrence 48-72 hours post-ED discharge, if history of migraines and recurrent headaches<ref>Colman et al Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ 2008 Jun.;336(7657):1359–1361</ref>
			** 10 mg IV single dose is commonly accepted regimen, 4 mg IV dose was shown to be as efficacious in a follow up study. <ref>Friedman BW, Solorzano C, Kessler BD, Martorello K, Lutz CL, Feliciano C, Adler N, Moss H, Cain D, Irizarry E. Randomized Trial Comparing Low- vs High-Dose IV Dexamethasone for Patients With Moderate to Severe Migraine. Neurology. 2023 Oct 3;101(14):e1448-e1454.</ref>

	====Other 2nd and 3rd Line Options====		====Other 2nd and 3rd Line Options====

Beren85: /* Other 2nd and 3rd Line Options */

2022-05-11T21:03:15Z

Other 2nd and 3rd Line Options

← Older revision		Revision as of 21:03, 11 May 2022
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	====Other 2nd and 3rd Line Options====		====Other 2nd and 3rd Line Options====
	*[[Magnesium]] 1 g IV over 30-60 minutes, low side effect profile, in treatment of acute migraine attacks<ref>Demirkaya S et al. Efficacy of intravenous magnesium sulfate in the treatment of acute migraine attacks. Headache. 2001 Feb;41(2):171-7.</ref>		*[[Magnesium]] 1-2 g IV over 30-60 minutes, low side effect profile, in treatment of acute migraine attacks<ref>Demirkaya S et al. Efficacy of intravenous magnesium sulfate in the treatment of acute migraine attacks. Headache. 2001 Feb;41(2):171-7.</ref>
	*[[Valproate]] sodium 500-1000 mg IV in 50 mL of NS over 20 minutes (alternatively 10 mg/kg IV, pediatrics, max 500 mg)<ref>Shahien R et al. Intravenous sodium valproate aborts migraine headaches rapidly. Acta Neurol Scand. 2011 Apr;123(4):257-65.</ref>		*[[Valproate]] sodium 500-1000 mg IV in 50 mL of NS over 20 minutes (alternatively 10 mg/kg IV, pediatrics, max 500 mg)<ref>Shahien R et al. Intravenous sodium valproate aborts migraine headaches rapidly. Acta Neurol Scand. 2011 Apr;123(4):257-65.</ref>
	*[[Droperidol]] IV/IM 1.25-2.75 mg, plus or minus diphenhydramine for extrapyramidal symptoms<ref>Thomas MC et al. Droperidol for the treatment of acute migraine headaches. Ann Pharmacother. 2015 Feb;49(2):233-40.</ref>		*[[Droperidol]] IV/IM 1.25-2.75 mg, plus or minus diphenhydramine for extrapyramidal symptoms<ref>Thomas MC et al. Droperidol for the treatment of acute migraine headaches. Ann Pharmacother. 2015 Feb;49(2):233-40.</ref>

Beren85: /* Non-specific Headache */

2022-05-11T21:02:42Z

Non-specific Headache

← Older revision		Revision as of 21:02, 11 May 2022
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	**6 mg SQ or IM, may repeat dose x1 after 1 hour, max 12 mg / 24 hours		**6 mg SQ or IM, may repeat dose x1 after 1 hour, max 12 mg / 24 hours
	**OR 100 mg PO, may repeat dose x1 after 2 hours, max 200 mg / 24 hours		**OR 100 mg PO, may repeat dose x1 after 2 hours, max 200 mg / 24 hours
			**OR 1-2 sprays IN (may repeat after 2 hours)
	**Contraindications to triptans include CV disease, uncontrolled [[HTN]], [[pregnancy]]		**Contraindications to triptans include CV disease, uncontrolled [[HTN]], [[pregnancy]]
	*Consider [[dexamethasone]] 10 mg IV single dose to prevent recurrence 48-72 hrs post-ED discharge, if history of recurrent headaches<ref>Colman et al Paraenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ 2008 Jun.;336(7657):1359–1361</ref>		*Consider [[dexamethasone]] 10 mg IV single dose to prevent recurrence 48-72 hrs post-ED discharge, if history of recurrent headaches<ref>Colman et al Paraenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ 2008 Jun.;336(7657):1359–1361</ref>

Spenceemmett: /* Other 2nd and 3rd Line Options */

2021-08-11T03:02:02Z

Other 2nd and 3rd Line Options

← Older revision		Revision as of 03:02, 11 August 2021
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	*Consider [[haloperidol]] IV 5 mg in IVF bolus with [[diphenhydramine]] to prevent need for rescue medications<ref>Gaffigan ME et al. A Randomized Controlled Trial of Intravenous Haloperidol vs. Intravenous Metoclopramide for Acute Migraine Therapy in the Emergency Department. J Emerg Med. 2015 Sep;49(3):326-34.</ref>		*Consider [[haloperidol]] IV 5 mg in IVF bolus with [[diphenhydramine]] to prevent need for rescue medications<ref>Gaffigan ME et al. A Randomized Controlled Trial of Intravenous Haloperidol vs. Intravenous Metoclopramide for Acute Migraine Therapy in the Emergency Department. J Emerg Med. 2015 Sep;49(3):326-34.</ref>
	*Consider 5-10 mg PO [[olanzapine]] (Zyprexa, Zydis) for prochlorperazine allergy<ref>Silberstein SD et al. Olanzapine in the treatment of refractory migraine and chronic daily headache. Headache. 2002 Jun;42(6):515-8.</ref><ref>Rozen TD. Olanzapine as an abortive agent for cluster headache. Headache. 2001;41(8):813-816.</ref>		*Consider 5-10 mg PO [[olanzapine]] (Zyprexa, Zydis) for prochlorperazine allergy<ref>Silberstein SD et al. Olanzapine in the treatment of refractory migraine and chronic daily headache. Headache. 2002 Jun;42(6):515-8.</ref><ref>Rozen TD. Olanzapine as an abortive agent for cluster headache. Headache. 2001;41(8):813-816.</ref>
	**While less extrapyramidal symptoms than typical antipsychotics, beware [[QT prolongation]]
	**Particularly useful in psych patients with mania, BPD, psychosis		**Particularly useful in psych patients with mania, BPD, psychosis
	**IV olanzapine may be as safe or safer than IM, with faster onset<ref>Farkas J. PulmCrit. PulmCrit- Intravenous olanzapine: Faster than IM olanzapine, safer than IV haloperidol? Feb 1, 2016. http://emcrit.org/pulmcrit/intravenous-olanzapine-haloperidol/</ref>		**IV olanzapine may be as safe or safer than IM, with faster onset<ref>Farkas J. PulmCrit. PulmCrit- Intravenous olanzapine: Faster than IM olanzapine, safer than IV haloperidol? Feb 1, 2016. http://emcrit.org/pulmcrit/intravenous-olanzapine-haloperidol/</ref>

Elcatracho: /* Non-specific Headache */

2021-03-07T23:07:24Z

Non-specific Headache

← Older revision		Revision as of 23:07, 7 March 2021
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	===Non-specific [[Headache]]===		===Non-specific [[Headache]]===
	''If known, treat specific headache type; avoid [[opioid]] medications if at all possible''		''If known, treat specific headache type; avoid [[opioid]] medications if at all possible''
	* 1st line: [[prochlorperazine]] (compazine) 10 mg IV (+/- [[diphenhydramine]] 25-50 mg IV) + 1 L ~~normal saline IV~~ bolus		* 1st line: [[prochlorperazine]] (compazine) 10 mg IV (+/- [[diphenhydramine]] 25-50 mg IV) + 1 L [[IVF]] bolus
	**Place prochlorperazine in IV bag to reduce chances of side effects from rapid administration		**Place prochlorperazine in IV bag to reduce chances of side effects from rapid administration
	**Alternative [[metoclopramide]] 10 mg IV<ref>Metoclopramide for Pain and Nausea in Patients with Migraine. Am Fam Physician. 2005 May 1;71(9):1770.</ref> ([[diphenhydramine]] addition shows no clinical benifit<ref>Friedman BW, et al. Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department-Based Randomized Clinical Trial. Annals of EM. January 2016. 67(1):32-39.</ref>)		**Alternative [[metoclopramide]] 10 mg IV<ref>Metoclopramide for Pain and Nausea in Patients with Migraine. Am Fam Physician. 2005 May 1;71(9):1770.</ref> ([[diphenhydramine]] addition shows no clinical benifit<ref>Friedman BW, et al. Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department-Based Randomized Clinical Trial. Annals of EM. January 2016. 67(1):32-39.</ref>)

Rossdonaldson1: /* Non-specific Headache */

2020-01-28T23:56:35Z

Non-specific Headache

← Older revision		Revision as of 23:56, 28 January 2020
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	===Non-specific [[Headache]]===		===Non-specific [[Headache]]===
	''~~Treat~~ specific headache type, if ~~known~~''		''If known, treat specific headache type; avoid [[opioid]] medications if at all possible''
	* 1st line: [[prochlorperazine]] (compazine) 10 mg IV (+/- [[diphenhydramine]] 25-50 mg IV) + 1 L normal saline IV bolus		* 1st line: [[prochlorperazine]] (compazine) 10 mg IV (+/- [[diphenhydramine]] 25-50 mg IV) + 1 L normal saline IV bolus
	**Place prochlorperazine in IV bag to reduce chances of side effects from rapid administration		**Place prochlorperazine in IV bag to reduce chances of side effects from rapid administration
Line 13:		Line 13:
	**Contraindications to triptans include CV disease, uncontrolled [[HTN]], [[pregnancy]]		**Contraindications to triptans include CV disease, uncontrolled [[HTN]], [[pregnancy]]
	*Consider [[dexamethasone]] 10 mg IV single dose to prevent recurrence 48-72 hrs post-ED discharge, if history of recurrent headaches<ref>Colman et al Paraenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ 2008 Jun.;336(7657):1359–1361</ref>		*Consider [[dexamethasone]] 10 mg IV single dose to prevent recurrence 48-72 hrs post-ED discharge, if history of recurrent headaches<ref>Colman et al Paraenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ 2008 Jun.;336(7657):1359–1361</ref>
	*Avoid [[opioid]] medications if possible

	====Other 2nd and 3rd Line Options====		====Other 2nd and 3rd Line Options====

Rossdonaldson1: /* Non-specific Headache */

2020-01-28T23:55:40Z

Non-specific Headache

← Older revision		Revision as of 23:55, 28 January 2020
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	**Alternative [[metoclopramide]] 10 mg IV<ref>Metoclopramide for Pain and Nausea in Patients with Migraine. Am Fam Physician. 2005 May 1;71(9):1770.</ref> ([[diphenhydramine]] addition shows no clinical benifit<ref>Friedman BW, et al. Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department-Based Randomized Clinical Trial. Annals of EM. January 2016. 67(1):32-39.</ref>)		**Alternative [[metoclopramide]] 10 mg IV<ref>Metoclopramide for Pain and Nausea in Patients with Migraine. Am Fam Physician. 2005 May 1;71(9):1770.</ref> ([[diphenhydramine]] addition shows no clinical benifit<ref>Friedman BW, et al. Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department-Based Randomized Clinical Trial. Annals of EM. January 2016. 67(1):32-39.</ref>)
	*[[Acetaminophen]] IV or PO, 325-1000 mg		*[[Acetaminophen]] IV or PO, 325-1000 mg
	* [[Ketorolac]] 30 mg IV		* [[Ketorolac]] 10-30 mg IV (30-60mg IM)
	**Lower doses are shown to be just as effective<ref>Brown CR, Moodie JE, Wild VM, Bynum LJ. Comparison of intravenous ketorolac tromethamine and morphine sulfate in the treatment of postoperative pain. Pharmacotherapy. 1990;10(6Patient 2):116S-121S.</ref>		**Lower doses are shown to be just as effective<ref>Brown CR, Moodie JE, Wild VM, Bynum LJ. Comparison of intravenous ketorolac tromethamine and morphine sulfate in the treatment of postoperative pain. Pharmacotherapy. 1990;10(6Patient 2):116S-121S.</ref>
	*[[Sumatriptan]] most effective within 6 hours of headache onset<ref>Efficacy and safety of intravenous acetylsalicylic acid lysinate compared to subcutaneous sumatriptan and parenteral placebo in the acute treatment of migraine. A double-blind, double-dummy, randomized, multicenter, parallel group study. The ASASUMAMIG Study Group. Diener HC. Cephalalgia. 1999 Jul; 19(6):581-8; discussion 542.</ref>		*[[Sumatriptan]] most effective within 6 hours of headache onset<ref>Efficacy and safety of intravenous acetylsalicylic acid lysinate compared to subcutaneous sumatriptan and parenteral placebo in the acute treatment of migraine. A double-blind, double-dummy, randomized, multicenter, parallel group study. The ASASUMAMIG Study Group. Diener HC. Cephalalgia. 1999 Jul; 19(6):581-8; discussion 542.</ref>

Rossdonaldson1: /* Other 2nd and 3rd Line Medications */

2020-01-28T23:53:14Z

Other 2nd and 3rd Line Medications

← Older revision		Revision as of 23:53, 28 January 2020
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	*Avoid [[opioid]] medications if possible		*Avoid [[opioid]] medications if possible

	====Other 2nd and 3rd Line ~~Medications~~====		====Other 2nd and 3rd Line Options====
	*[[Magnesium]] 1 g IV over 30-60 minutes, low side effect profile, in treatment of acute migraine attacks<ref>Demirkaya S et al. Efficacy of intravenous magnesium sulfate in the treatment of acute migraine attacks. Headache. 2001 Feb;41(2):171-7.</ref>		*[[Magnesium]] 1 g IV over 30-60 minutes, low side effect profile, in treatment of acute migraine attacks<ref>Demirkaya S et al. Efficacy of intravenous magnesium sulfate in the treatment of acute migraine attacks. Headache. 2001 Feb;41(2):171-7.</ref>
	*[[Valproate]] sodium 500-1000 mg IV in 50 mL of NS over 20 minutes (alternatively 10 mg/kg IV, pediatrics, max 500 mg)<ref>Shahien R et al. Intravenous sodium valproate aborts migraine headaches rapidly. Acta Neurol Scand. 2011 Apr;123(4):257-65.</ref>		*[[Valproate]] sodium 500-1000 mg IV in 50 mL of NS over 20 minutes (alternatively 10 mg/kg IV, pediatrics, max 500 mg)<ref>Shahien R et al. Intravenous sodium valproate aborts migraine headaches rapidly. Acta Neurol Scand. 2011 Apr;123(4):257-65.</ref>

← Older revision		Revision as of 22:34, 20 March 2026
Line 1:		Line 1:
	===Non-specific [[Headache]]===		===Non-specific [[Headache]]===
	''If known, treat specific headache type; avoid [[opioid]] medications if at all possible''		''If known, treat specific headache type; avoid [[opioid]] medications if at all possible''
	* 1st line: ~~[[prochlorperazine]] (compazine)~~ 10 mg IV (+/- ~~[[diphenhydramine]]~~ 25-50 mg IV) + 1 L [[IVF]] bolus		* 1st line: {{MedicationDose\|drug=Prochlorperazine\|dose=10 mg IV\|route=IV\|context=1st line headache abortive\|indication={{PAGENAME}}\|population=Adult}} (+/- {{MedicationDose\|drug=Diphenhydramine\|dose=25-50 mg IV\|route=IV\|context=Adjunct to prevent akathisia\|indication={{PAGENAME}}\|population=Adult}}) + 1 L [[IVF]] bolus
	**Place prochlorperazine in IV bag to reduce chances of side effects from rapid administration		**Place prochlorperazine in IV bag to reduce chances of side effects from rapid administration
	**Alternative ~~[[metoclopramide]]~~ 10 mg IV<ref>Metoclopramide for Pain and Nausea in Patients with Migraine. Am Fam Physician. 2005 May 1;71(9):1770.</ref> ([[diphenhydramine]] addition shows no clinical ~~benifit~~<ref>Friedman BW, et al. ~~Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department-Based~~ Randomized ~~Clinical Trial. Annals~~ of EM. ~~January 2016. 67(~~1~~):32~~-~~39.~~</ref>)		**Alternative {{MedicationDose\|drug=Metoclopramide\|dose=10 mg IV\|route=IV\|context=Alternative abortive\|indication={{PAGENAME}}\|population=Adult}}<ref>Metoclopramide for Pain and Nausea in Patients with Migraine. Am Fam Physician. 2005 May 1;71(9):1770.</ref> ([[diphenhydramine]] addition shows no clinical difference in effectiveness<ref>Friedman BW, Irizarry E, Solorzano C, et al. Randomized study of IV prochlorperazine plus diphenhydramine vs IV prochlorperazine alone for migraine in the ED. Neurology 2017;89:1-6</ref>)
	*[[Acetaminophen]] IV or PO, 325-1000 mg		*[[Acetaminophen]] IV or PO, 325-1000 mg
	* [[Ketorolac~~]] 10~~-30 mg IV (30-~~60mg~~ IM)		* {{MedicationDose\|drug=Ketorolac\|dose=15-30 mg IV (30-60 mg IM)\|route=IV/IM\|context=NSAID for headache\|indication={{PAGENAME}}\|population=Adult}}
	**Lower doses are shown to be just as effective<ref>Brown CR, Moodie JE, Wild VM, Bynum LJ. Comparison of intravenous ketorolac tromethamine and morphine sulfate in the treatment of postoperative pain. Pharmacotherapy. 1990;10(6Patient 2):116S-121S.</ref>		**Lower doses are shown to be just as effective<ref>Brown CR, Moodie JE, Wild VM, Bynum LJ. Comparison of intravenous ketorolac tromethamine and morphine sulfate in the treatment of postoperative pain. Pharmacotherapy. 1990;10(6Patient 2):116S-121S.</ref>
	*[[Sumatriptan]] most effective within ~~6 hours~~ of ~~headache~~ onset<ref>Efficacy and safety of intravenous acetylsalicylic acid lysinate compared to subcutaneous sumatriptan and parenteral placebo in the acute treatment of migraine~~. A double-blind, double-dummy, randomized, multicenter, parallel group study. The ASASUMAMIG Study Group. Diener HC~~. Cephalalgia. 1999 ~~Jul~~; 19(6):~~581~~-~~8; discussion 542~~.</ref>		*{{MedicationDose\|drug=Sumatriptan\|dose=6 mg SC/IM (or 100 mg PO, or 1-2 sprays IN)\|route=SC/IM/PO/IN\|context=Triptan, most effective within 6h of onset\|indication={{PAGENAME}}\|population=Adult\|notes=Max 12 mg SC/24h or 200 mg PO/24h}} <ref>Efficacy and safety of intravenous acetylsalicylic acid lysinate compared to subcutaneous sumatriptan and parenteral placebo in the acute treatment of migraine attacks. Cephalalgia. 1999;19(3):155-164.</ref>
	**Serotonin 5HT1B/1D receptor agonist (e.g. [[sumatriptan]])		**Serotonin 5HT1B/1D receptor agonist (e.g. [[sumatriptan]])
	**6 mg SQ or IM, may repeat dose x1 after 1 hour, max 12 mg / 24 hours		**6 mg SQ or IM, may repeat dose x1 after 1 hour, max 12 mg / 24 hours
Line 13:		Line 13:
	**OR 1-2 sprays IN (may repeat after 2 hours)		**OR 1-2 sprays IN (may repeat after 2 hours)
	**Contraindications to triptans include CV disease, uncontrolled [[HTN]], [[pregnancy]]		**Contraindications to triptans include CV disease, uncontrolled [[HTN]], [[pregnancy]]
	*[[Dexamethasone~~]] to prevent~~ recurrence 48-~~72 hours~~ post-ED discharge~~, if history of migraines and/or recurrent headaches~~<ref>Colman et al Parenteral dexamethasone for acute severe migraine headache: meta-analysis of ~~randomised controlled trials~~ for preventing ~~recurrence~~. BMJ 2008 ~~Jun.~~;336(7657):~~1359–1361~~</ref>		*{{MedicationDose\|drug=Dexamethasone\|dose=4-10 mg IV x1\|route=IV\|context=Prevent headache recurrence 48-72h post-discharge\|indication={{PAGENAME}}\|population=Adult}}<ref>Colman et al Parenteral dexamethasone for acute severe migraine headache: meta-analysis of RCTs for preventing relapse. BMJ. 2008;336(7657):1359-61</ref>
	** 10 mg IV single dose is commonly accepted regimen, 4 mg IV dose was shown to be as efficacious in a follow up study. <ref>Friedman BW, Solorzano C, Kessler BD, Martorello K, Lutz CL, Feliciano C, Adler N, Moss H, Cain D, Irizarry E. Randomized Trial Comparing Low- vs High-Dose IV Dexamethasone for Patients With Moderate to Severe Migraine. Neurology. 2023 Oct 3;101(14):e1448-e1454.</ref>		** 10 mg IV single dose is commonly accepted regimen, 4 mg IV dose was shown to be as efficacious in a follow up study. <ref>Friedman BW, Solorzano C, Kessler BD, Martorello K, Lutz CL, Feliciano C, Adler N, Moss H, Cain D, Irizarry E. Randomized Trial Comparing Low- vs High-Dose IV Dexamethasone for Patients With Moderate to Severe Migraine. Neurology. 2023 Oct 3;101(14):e1448-e1454.</ref>

	====Other 2nd and 3rd Line Options====		====Other 2nd and 3rd Line Options====
	*[[Magnesium]] 1-2 g IV over 30-60 ~~minutes, low side effect profile, in treatment of~~ acute ~~migraine attacks~~<ref>Demirkaya S et al. Efficacy of intravenous magnesium sulfate in the treatment of acute migraine attacks. Headache~~. 2001 Feb;~~41(2):171-7.</ref>		*{{MedicationDose\|drug=Magnesium sulfate\|dose=1-2 g IV over 30-60 min\|route=IV\|context=2nd/3rd line for acute headache\|indication={{PAGENAME}}\|population=Adult}}<ref>Demirkaya S et al. Efficacy of intravenous magnesium sulfate in the treatment of acute migraine attacks. Headache, 41 (2001), pp. 171-177</ref>
	*~~[[Valproate]] sodium~~ 500-1000 mg IV in 50 mL of NS over 20 ~~minutes~~ (~~alternatively~~ 10 mg/kg ~~IV, pediatrics~~, max 500 mg)<ref>Shahien R et al. Intravenous sodium valproate aborts migraine headaches rapidly. Acta Neurol Scand. 2011 Apr;123(4):257-65.</ref>		*{{MedicationDose\|drug=Valproic acid\|dose=500-1000 mg IV in 50 mL NS over 20 min (peds: 10 mg/kg, max 500 mg)\|route=IV\|context=2nd/3rd line for acute headache\|indication={{PAGENAME}}\|population=Adult\|display=Valproate sodium}}<ref>Shahien R et al. Intravenous sodium valproate aborts migraine headaches rapidly. Acta Neurol Scand. 2011 Apr;123(4):257-65.</ref>
	*[[Droperidol~~]] IV/IM~~ 1.25-2.75 mg~~, plus~~ or ~~minus diphenhydramine~~ for ~~extrapyramidal symptoms~~<ref>Thomas MC et al. Droperidol for the treatment of acute migraine headaches. Ann Pharmacother. 2015 Feb;49(2):233-40.</ref>		*{{MedicationDose\|drug=Droperidol\|dose=1.25-2.75 mg IV or IM\|route=IV/IM\|context=2nd/3rd line for acute headache\|indication={{PAGENAME}}\|population=Adult\|notes=Monitor EKG for QTc prolongation}}<ref>Thomas MC et al. Droperidol for the treatment of acute migraine headaches. Ann Pharmacother. 2015 Feb;49(2):233-40.</ref>
	**Perform EKG monitoring for patients at risk of QTc prolongation		**Perform EKG monitoring for patients at risk of QTc prolongation
	**Do not give to patients who take already multiple QT prolonging drugs		**Do not give to patients who take already multiple QT prolonging drugs