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 #Migraine #management #algorithm #treatment #prevention #prophylaxis #neurology #cocktail #prophylaxis
