Treatment Of Intractable Migraine Research Articles

Emergency Department and Inpatient Management of Status Migrainosus and Intractable Headache.

This article discusses the treatment of status migrainosus in the emergency department and the treatment of intractable migraine in an inpatient setting. Multiple agents of various drug classes have been tried for the treatment of acute migraine in the emergency department, but few have adequate medical evidence to support their use. Opioids, which are less effective than other medications used for the acute treatment of migraine and also carry the risk of adverse CNS side effects, habituation, and addiction, have been prescribed for migraine in the emergency department at an increasing rate over the last decade, which is a worrisome trend. Very few patients with migraine derive sustained relief from pain after emergency department treatment, and most have a high frequency of headache recurrence. Treatment of status migrainosus and intractable migraine should focus on adequate fluid hydration and combination IV therapy with multiple nonopioid medications from multiple drug classes. Dopamine receptor antagonists appear to have some of the highest medical evidence for efficacy.

Labetalol for prophylactic treatment of intractable migraine during pregnancy.

Headaches tend to improve in the majority of migraineurs during pregnancy, but some patients report a worsening of migraine and present a management challenge because of the restrictions of pharmacotherapy during pregnancy. Treatment options become even more limited for pregnant migraineurs who develop preeclampsia. Labetalol was tried successfully in reducing the frequency, duration, and intensity of migraine attacks in a pregnant woman with preeclampsia. There were no significant side effects and the patient delivered a healthy baby without complications.