What IV medications can be used for a patient with a headache rated 7/10 who is scheduled for an Esophagogastroduodenoscopy (EGD) in the morning?

IV Medications for Acute Headache in a Patient Awaiting EGD

For a patient with a 7/10 headache who is scheduled for an EGD in the morning, IV ketorolac 10 mg is the most appropriate IV medication to administer. 1

First-line IV Treatment Options

IV NSAIDs

• IV Ketorolac (Toradol):
  • Recommended dose: 10 mg IV (analgesic ceiling dose) 1
  • Provides effective pain relief without increased adverse effects compared to higher doses
  • Particularly beneficial for moderate to severe headache
  • Onset of action: 10-30 minutes
  • Duration: 4-6 hours
  • Cautions: Avoid in patients with peptic ulcer disease, renal insufficiency, or bleeding disorders 2

IV Antiemetics with Analgesic Properties

• IV Metoclopramide (Reglan):

  • Dose: 10 mg IV
  • Dual benefit: treats headache pain and improves gastric motility (beneficial for patient undergoing EGD)
  • Particularly useful if nausea accompanies the headache 2

• IV Prochlorperazine (Compazine):

  • Dose: 10 mg IV
  • Effective for headache pain relief
  • May cause more sedation than metoclopramide 3
  • Some studies show superior pain relief compared to ketorolac 3

Algorithm for Selection

1. Assess contraindications:

   • If patient has renal disease, GI bleeding risk, or coagulopathy → avoid ketorolac
   • If patient has history of dystonic reactions or is on medications that may interact with antiemetics → avoid metoclopramide/prochlorperazine

2. Consider headache characteristics:

   • If headache has migrainous features (throbbing, photophobia, phonophobia) → antiemetics may be particularly effective 2
   • If headache is tension-type or non-specific → ketorolac is appropriate

3. Consider EGD preparation:

   • Since patient is scheduled for EGD in morning, metoclopramide has added benefit of improving gastric motility

Important Considerations for EGD Preparation

• Avoid opioids as they can cause respiratory depression and may interfere with sedation for the EGD procedure 2
• Avoid medications that may increase bleeding risk unnecessarily, though a single dose of ketorolac is unlikely to significantly impact bleeding risk for the procedure
• Consider that the patient will likely be NPO (nothing by mouth) status, making IV medications necessary

Pitfalls to Avoid

• Do not use IV opioids as first-line therapy for headache, especially before a procedure requiring sedation 2
• Do not administer higher doses of ketorolac (15-30 mg) as they provide no additional analgesic benefit over 10 mg but may increase risk of adverse effects 1
• Do not ignore nausea or vomiting if present, as these symptoms may require specific treatment with antiemetics
• Avoid medications that may interfere with the EGD procedure scheduled for the morning

Follow-up Assessment

• Reassess pain 30-60 minutes after administration
• If inadequate relief (pain remains >4/10), consider adding a second agent from a different class
• Document response to inform post-procedure pain management plan

For this specific patient with a 7/10 headache awaiting EGD, IV ketorolac 10 mg provides effective analgesia with minimal risk of interfering with the upcoming procedure.