Contributor: Don Stader, MD

Educational Pearls:

• The classic migraine cocktail includes: Reglan (or other dopamine antagonist), Benadryl, Toradol, Decadron, and IV fluids.
• The most effective agent in the cocktail is a dopaminergic agent
• Routine IV fluids have not shown efficacy
• There is no evidence for pre-treatment of akathisia with diphenhydramine (Benadryl)
• Decadron reduces rebound headache
• Consider trigger point injections for those with migraine attributable to cervical neck pain.

References

Jones CW, Remboski LB, Freeze B, Braz VA, Gaughan JP, McLean SA..Intravenous Fluid for the Treatment of Emergency Department Patients With Migraine Headache: A Randomized Controlled Trial. Ann Emerg Med. 2019 Feb;73(2):150-156. doi: 10.1016/j.annemergmed.2018.09.004. Epub 2018 Oct 26.

Friedman BW, Cabral L, Adewunmi V, et al. Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department-Based Randomized Clinical Trial. Ann Emerg Med. 2016;67(1):32–39.e3. doi:10.1016/j.annemergmed.2015.07.495

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD