Stepwise management of acute headache in the emergency ...

Stepwise management of acute headache in the emergency department 

1) Metoclopramide 10 mg IV or prochlorperazine 10 mg IV or droperidol 2.5 mg IV or haloperidol 5mg IV. Consider co-administering diphenhydramine 25mg IV to prevent akathisia, especially if using prochlorperazine; though this appears unnecessary if using metoclopramide. All medication should be administered over 5 to 

15 minutes. Add dexamethasone (either at the outset of care or prior to discharge) 10 mg 

IV to prevent headache recurrence. 

2) If insufficient relief: A second dose of the anti-dopaminergic plus ketorolac 15 mg IV. 

3) If insufficient relief: A third dose of either of the 

above medication plus DHE I mg IV over 15 


4) If insufficient relief: Consider greater occipital nerve block, emerging therapy listed in Table 2, or an opioid if the patient has no flags for opioid misuse. 

#Headache #Management #Stepwise #Algorithm
Contributed by

Dr. Gerald Diaz
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief πŸ‡΅πŸ‡­ πŸ‡ΊπŸ‡Έ - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG: | Twitter:

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