Management of Migraine at Emergency Department

Abstract

Migraine is a chronic neurologic disease characterized by recurrent headache generally unilateral, throbbing, moderate to severe in intensity, made worse by the effort and associated with symptoms such as nausea or sensivity to light and sounds. It's the most common primary headache and one of the main disabling diseases in the world, being a usual reason for visiting the emergency department. There are many therapeutic options that motivated to investigate types of commonly used drugs, existence of protocols and treatment efectiveness on acute migraine. 

The objective was to compare daily clinical practice with literal evidence regarding the management of acute migraine.

It was a descriptive study based on semi-structured survey of 100 physicians from public and private emergency departments in Cordoba city during the period of july 2018 and may 2019.

The drugs usually used are: dipyrone (63%), dexamethasone (46%), methoclorpramide (46%), ketorolac (43%), diclofenac (32%), ergotamine (5%), triptans (4%), diazepam (1%), prochlorpromazin (1%). The 92% of physicians claimed that the workplace doesn't have standart protocol. Finally, the pain totally improves in 37% of patients and parcially improve in 63% of patients.

CONCLUSION: The results partially agree with update international guides wich suggests the use of metoclorpramide, prochlorpromazine, sumatriptan as B evidence level and dipirone, ketorolac, acetaminophen, aspirin, chlorpromazine, diclofenac, haloperidol an valproico as C evidence level for migaine treatment. There isn't enough evidence about the benefit of dexamethasone although it is widely used in our place. This could be related to poor therapeutic response also demonstrated in the present study. Despite the existent of international guides, they aren't used on daily clinical practices, maybe because prevoius experiencie with certain drugs, concerns about adverse effects or availabillity