Migraine - acute - 5
Patients with minor uncomplicated migraines may respond to compound analgesia e.g. paracetamol and codeine preparations +/- anti-emetics, although this combination is often tried by patients before they come to the ED.
Most migraine patients can be managed in the Emergency Department. Those not responding quickly to treatment which is normally effective should have their diagnosis re-evaluated - is it migraine.
Severe intractable cases may require admission to hospital, especially cases of 'status migrainosus' where the headache can last for several days.
Intractable headache should be re-evaluated by a senior doctor to look for organic or psychiatric/psychological problems.
Patients should be warned that recurrence of the headache after hospital treatment is normal.
Follow-up care through their GP should be arranged, with possible preventitave medications.
There is some evidence that the phenothiazines + intravenous fluid regime seem good at preventing this 'rebound' headache.