Managing and Preventing Migraine in the Emergency Department: A Review

Miguel A Cortel-LeBlanc; Serena L Orr; Maeghan Dunn; Daniel James; Achelle Cortel-LeBlanc

doi:10.1016/j.annemergmed.2023.05.024

Managing and Preventing Migraine in the Emergency Department: A Review

Ann Emerg Med. 2023 Dec;82(6):732-751. doi: 10.1016/j.annemergmed.2023.05.024. Epub 2023 Jul 11.

Authors

Miguel A Cortel-LeBlanc¹, Serena L Orr², Maeghan Dunn³, Daniel James⁴, Achelle Cortel-LeBlanc⁵

Affiliations

¹ Department of Emergency Medicine, Queensway Carleton Hospital, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada; 360 Concussion Care, Ottawa, ON, Canada. Electronic address: mcortelleblanc@gmail.com.
² Departments of Pediatrics, Community Health Sciences, and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
³ Department of Emergency Medicine, Queensway Carleton Hospital, Ottawa, ON, Canada.
⁴ Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
⁵ Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada; 360 Concussion Care, Ottawa, ON, Canada; Division of Neurology, Department of Medicine, Queensway Carleton Hospital, Ottawa, ON, Canada.

PMID: 37436346
DOI: 10.1016/j.annemergmed.2023.05.024

Abstract

Migraine is a leading cause of disability worldwide, and acute migraine attacks are a common reason for patients to seek care in the emergency department (ED). There have been recent advancements in the care of patients with migraine, specifically emerging evidence for nerve blocks and new pharmacological classes of medications like gepants and ditans. This article serves as a comprehensive review of migraine in the ED, including diagnosis and management of acute complications of migraine (eg, status migrainosus, migrainous infarct, persistent aura without infarction, and aura-triggered seizure) and use of evidence-based migraine-specific treatments in the ED. It highlights the role of migraine preventive medications and provides a framework for emergency physicians to prescribe them to eligible patients. Finally, it evaluates the evidence for nerve blocks in the treatment of migraine and introduces the possible role of gepants and ditans in the care of patients with migraine in the ED.

Keywords: Migraine; emergency; prophylaxis; status migrainosus.

Publication types

Review

MeSH terms

Emergency Service, Hospital
Epilepsy* / complications
Humans
Migraine Disorders* / prevention & control
Seizures