Guidelines Updated on Use of Parenteral Meds for Migraine in Emergency Department

THURSDAY, Dec. 11, 2025 (HealthDay News) — The American Headache Society has updated the guidelines on the use of parenteral pharmacologic therapies for management of migraine attacks in the emergency department; the update was published online Dec. 1 in Headache.

Jennifer Robblee, M.D., from Dignity Health in Phoenix, and colleagues conducted a systematic review and meta-analysis to update the 2016 American Headache Society guidelines on parenteral pharmacologic therapies for management of migraine attacks. Eligible studies were randomized controlled trials (RCTs) involving adults diagnosed with migraine, treated with intravenous (IV), intramuscular, subcutaneous, or nerve block (including sphenopalatine ganglion [SGP] block) interventions in the emergency department.

Twenty-six new RCTs evaluating 20 injectable treatments were identified. Of these, 12, nine, and four were rated as class I (low risk for bias), class II, and class III, respectively. The researchers developed recommendations for each intervention. For eligible adults presenting to the emergency department with a migraine attack, without contraindications, the recommendations indicate prochlorperazine IV and greater occipital nerve blocks must be offered, while hydromorphone IV must not be offered. Chlorpromazine IV, dexamethasone IV, and valproate IV may be offered, while acetaminophen IV may not be offered. For patients closely matching the clinical trial population only, eptinezumab should be offered, but is rated level U (no recommendation for an emergency department-specific population). For caffeine, granisetron, ibuprofen, ketamine, lidocaine, normal saline, propofol, and SPG blocks, additional evidence is needed and all are rated level U.

“These guidelines formally recommend nerve blocks as an evidence-based treatment for acute migraine attacks in the emergency department,” Robblee said in a statement. “Integrating this option into practice can offer patients faster pain relief and expand the tools available to emergency clinicians.”

Several authors disclosed ties to the biopharmaceutical industry.

Abstract/Full Text