Acute ED Migraine Therapy and Preventative Therapy Algorithm:

Acute migraine

 • IV NS IL bolus then infusion @ 100cc/h

 • Acetaminophen 1g PO

 • Ketorolac IV

 • Metoclopromide 10 mg IV

 • Sumatriptan 6mg SC

 • Dexamethasone 10 mg IV (to prevent recurrence)

Not Ready for Discharge after 1hr

 • Sphenopalatine Ganglion Block and/or magnesium 1-2g IV

Not Ready for Discharge after 1hr

 • Valproic Acid 900 mg IV  @ 20 mg/min

-> Neurology Consult

Preventative Medications:

 • Metoprolol 50 mg PO bid 

 • Amitriptyline 10 mg PO hs

 • Topiramate 25 mg PO hs

Preventative Nutraceuticals:

 • Magnesium (citrate or glycinate) 200mg BID

 • Riboflavin (Vitamin B2) 200mg BID

 • Coenzyme Q 10 150mg BID

 • Melatonin 3-5mg qhs



By Dr. Maeghan Fu & Dr. Miguel Cortel-LeBlanc



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