In this issue, we collaborated with the CJEM team to create a visual abstract on the article “Optimal management strategies for primary headache in the emergency department.”1
Primary headaches, such as migraine or tension headache, are among some of the most frequently encountered conditions in the emergency department. Despite this, there are many variations in treatment, from choice of pain and nausea control, to the decision of whether or not to give IV fluids. Wouldn’t it be so much easier if there was one standard, agreed-upon treatment regimen?
Enter this recent study by Wells et al. In this study, authors sought to de-mystify primary headache management by identifying management patterns that were associated with more rapid resolution of symptoms and decreased need for a second round of medications.
The authors found that the use of NSAIDs (ketorolac, ibuprofen, naproxen) and dopamine antagonists (metoclopramide, haloperidol) were associated with a decreased need for second round medications (OR 0.50 and 0.27, respectively), whereas receiving more than 500mL of IV fluids and non-dopaminergic antiemetics (dimenhydrinate, ondansetron) was associated with an increased need for second round medications (OR 2.79 and 2.21, respectively). Clinicians should select appropriate first-line medications, such as ketorolac IV and metoclopramide IV when managing a low-risk primary headache to increase initial treatment success and reduce the need for second round medication.
- 1.Wells S, Stiell IG, Vishnyakova E, Lun R, Nemnom M-J, Perry JJ. Optimal management strategies for primary headache in the emergency department. Can J Emerg Med. Published online August 14, 2021. doi:10.1007/s43678-021-00173-0