Use of Oral Rehydration Salts During Headache Attacks
Oral rehydration salts (ORS) are safe and appropriate for hydration during headache attacks in most patients, including those with underlying conditions, with specific contraindications limited to severe dehydration with altered mental status, ileus, or inability to tolerate oral intake. 1, 2
Safety Profile and General Use
ORS solutions are well-tolerated across all age groups and can be safely used in the presence of both hypernatremia and hyponatremia (except when edema is present). 1 The low-osmolarity formulations recommended by the World Health Organization contain an appropriate balance of electrolytes (sodium 50-90 mEq/L) and glucose that effectively promotes water and electrolyte absorption regardless of the underlying cause of fluid loss. 1, 3, 2
Evidence for Hydration in Headache Management
While lifestyle modifications including adequate hydration are recommended for all headache disorders, the specific evidence for ORS use during headache attacks is limited. 1 A pilot study demonstrated that increasing daily water intake by approximately 1 liter reduced total headache hours by 21 hours over 2 weeks and decreased mean headache intensity by 13 mm on a visual analogue scale. 4 However, intravenous fluids administered for acute migraine attacks in emergency department settings have not been shown to improve pain outcomes. 5
For patients experiencing headache with concurrent dehydration, ORS represents the preferred first-line rehydration strategy over intravenous fluids. 1, 6
Specific Considerations for Underlying Conditions
Patients with Renal Impairment
- ORS can be used safely with monitoring of electrolyte balance 1
- The sodium content (50-90 mEq/L) in standard ORS formulations is generally well-tolerated 1, 3
- Avoid hypertonic solutions that may exacerbate fluid shifts 1
Patients with Heart Failure
- ORS is safe when edema is not present 1
- In the presence of edema, ORS should be avoided and alternative hydration strategies considered 1
- Monitor for fluid overload, particularly in patients with compromised cardiac function 1
Absolute Contraindications to ORS
ORS should NOT be used in the following situations: 1, 2
- Severe dehydration with altered mental status (requires IV fluids first) 1, 6
- Presence of ileus or gastrointestinal obstruction 1, 7
- Inability to tolerate oral or nasogastric intake 1, 2
- Anatomical gastrointestinal abnormalities or severe malabsorption 2
Practical Administration Guidelines
For mild to moderate dehydration during headache attacks: 1, 6
- Administer ORS at 50-100 mL/kg over 3-4 hours for initial rehydration 1
- Continue ad libitum intake (up to 2 L/day for adults) to replace ongoing losses 1
- Reassess hydration status after 2-4 hours 6
Commercially available ORS formulations include: 1
- Pedialyte Liters (Abbott Nutrition)
- CeraLyte (Cero Products)
- Enfalac Lytren (Mead Johnson)
What NOT to Use
Avoid the following beverages for rehydration during headache attacks: 1
- Apple juice, sports drinks (Gatorade), and commercial soft drinks 1
- Plain water, tea, coffee, or alcohol (hypotonic solutions) 1
- Fruit juices and colas (hypertonic solutions) 1
These beverages lack the appropriate sodium-glucose balance needed for optimal fluid absorption and may actually worsen dehydration in some cases. 1
When to Transition to IV Fluids
Switch to intravenous hydration if: 1, 6
- Patient develops severe dehydration with hemodynamic instability 1
- ORS therapy fails after appropriate trial 1, 6
- Patient develops ketonemia preventing oral tolerance 1, 6
- Ileus develops during treatment 1, 7
Once clinical improvement occurs with IV fluids, transition back to ORS as soon as oral intake is tolerated. 1, 6
Integration with Headache Management
ORS use should be incorporated into comprehensive headache management that includes: 1