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Headache, Migraine, Emergency Medicine

Reviewed 06/2017



  • Chronic episodic headache disorder

  • Neurovascular pathophysiology:

    • Aberrant trigeminal nerve activation

    • Activation of nociceptive pathways within brainstem

    • Vascular dilation reactive rath...


Signs and Symptoms


  • May be precipitated by chocolate, cheese, nuts, alcohol, sulfites, monosodium glutamate (MSG), stress, or menstruation

  • Prodrome precedes migraine by several days

    • May c...



  • Allow patients with migraine headache to be in a calm, dark environment

  • Oxygen may be beneficial

Initial Stabilization/Therapy

  • Exclude secondary causes of headache

  • Rapid and effectiv...



Admission Criteria

  • Persistent severe headache or focal neurologic deficits

  • Intractable vomiting, electrolyte imbalance, or inability to take oral food or fluid

  • Coexisting medication ...

Pearls and Pitfalls

  • Opioids should not be used as first-line therapy in the ED

  • Migraine likely to recur after ED discharge—patients should go home with prescription

  • Distinguish between migraine, a chron...

Additional Reading

  • Friedman  BW, Lipton  RB. Headache in the emergency department. Curr Pain Headache Rep.  2011;15:302–307.

  • Friedman  BW, Serrano  D, Reed  M, et al. Use of the emergency departme...



  • 346.00 Migraine with aura, without mention of intractable migraine without mention of status migrainosus

  • 346.10 Migraine without aura, without mention of intractable migraine without mention ...

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