From the Guidelines
Alternative Treatments for Acute Migraines
For the treatment of acute migraines in the emergency department, alternative options to metoclopramide and NSAIDs include:
- Sumatriptan, administered as a 4-6 mg subcutaneous injection, with a maximum dose of 12 mg in 24 hours 1.
- Ergotamine tartrate, 1-2 mg intravenously, may be considered 1.
- Butorphanol nasal spray, which has shown good evidence for efficacy in treating acute migraines 1.
- Dihydroergotamine (DHE) nasal spray, which has good evidence for efficacy and safety in treating acute migraine attacks 1.
These options are considered when NSAIDs and metoclopramide are not suitable or effective. It's essential to evaluate each patient's specific needs and medical history before selecting an alternative treatment. The choice of treatment should be based on the severity of the migraine, the presence of nausea or vomiting, and the patient's response to previous treatments.
Key Considerations
- Contraindications: Triptans, such as sumatriptan, are contraindicated in patients with risk for heart disease, basilar or hemiplegic migraine, or uncontrolled hypertension 1.
- Adverse Effects: Ergotamines can cause frequent adverse events, and their use should be carefully considered 1.
- Nausea and Vomiting: For patients with significant nausea or vomiting, a non-oral route of administration may be preferred, and antiemetics should be considered 1.
From the FDA Drug Label
Although most of the people who have taken IMITREX have not had any serious side effects, some have had serious heart problems. The use of IMITREX Injection during pregnancy: Do not take IMITREX Injection if you are pregnant, think you might be pregnant, are trying to become pregnant, or are not using adequate contraception unless you have talked with your healthcare provider about this How to take IMITREX Injection: For adults, the usual dose is a single injection given just below the skin. Some possible side effects of IMITREX Injection Some patients feel pain or tightness in the chest or throat when using IMITREX Injection. Occasionally, it is necessary to lower the dosage of prochlorperazine or to discontinue the drug. Adverse reactions with different phenothiazines vary in type, frequency, and the mechanism of occurrence, i.e., some are dose-related, while others involve individual patient sensitivity.
Four alternative treatments for acute migraines in the Emergency Department (ED) that are not Metoclopramide (Reglan) or Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are:
- Sumatriptan (SQ): a triptan used to relieve migraine or cluster headache attacks 2
- Prochlorperazine (IV): an antipsychotic agent that can be used to treat migraines, although it may have adverse reactions 3
- Dihydroergotamine (DHE): not mentioned in the provided drug labels, but a possible alternative treatment for acute migraines
- Lidocaine: not mentioned in the provided drug labels, but a possible alternative treatment for acute migraines
Note: The FDA drug labels provided do not explicitly mention Dihydroergotamine (DHE) or Lidocaine as alternative treatments for acute migraines. However, they are sometimes used in clinical practice. It is essential to consult with a healthcare provider before administering any medication.
From the Research
Alternative Treatments for Acute Migraines
The following are four alternative treatments for acute migraines in the Emergency Department (ED) that are not Metoclopramide (Reglan) or Non-Steroidal Anti-Inflammatory Drugs (NSAIDs):
- Dihydroergotamine: This medication has some data supporting its efficacy in treating acute migraines 4.
- Valproic acid: This medication has some data supporting its efficacy in treating acute migraines 4.
- Greater occipital nerve blocks (GONBs): GONBs have been shown to be efficacious in treating acute migraines 4.
- Corticosteroids: Corticosteroids, such as dexamethasone, can be used to prevent recurrence of headache after discharge from the ED 5, 6.
Efficacy of Alternative Treatments
These alternative treatments have been studied in various clinical trials and have shown promise in treating acute migraines. For example, dihydroergotamine and valproic acid have been shown to be effective in some patients 4, while GONBs have been shown to be efficacious in treating acute migraines 4. Corticosteroids, such as dexamethasone, have been shown to prevent recurrence of headache after discharge from the ED 5, 6.
Considerations for Treatment
When considering alternative treatments for acute migraines, it is essential to take into account the individual patient's needs and medical history. For example, patients who have failed to respond to first-line treatments, such as metoclopramide or sumatriptan, may be candidates for alternative treatments 7, 6. Additionally, patients who have certain medical conditions, such as cardiovascular disease, may need to avoid certain medications, such as triptans 8.