GREAT article from ER doc perspective on migraines.........interesting

Good article. Thank you for the link.

This is interesting:

Opioid analgesics. In an emergency department setting, opioid treatment for migraine should be avoided. Recent findings suggest that patients presenting with acute episodic migraine may develop chronic migraine after receiving parenteral opioids. This was found to be particularly problematic for patients who had been opioid-naive prior to treatment.

I used to get migraines once in a while and now I have them nearly everyday. I wonder if a trip to the ER is responsible????

How come none of my Doctors have suggested this? I have had a 20 year history of migraine and spent the last year on State Disability for it. I'm not better off than when I filed and now I'm back to work - with migraines.

RESCUE THERAPY AND PROCEDURALLY ORIENTED TREATMENT

Some headache specialists are allowing migraineurs who occasionally fail abortive therapy to use olanzapine 10 mg as a rescue drug. Patients are instructed to use the olanzapine only if their headache worsens after taking two doses of the same triptan within 24 hours.

Olanzapine will induce a six- to eight-hour period of sleep, after which the patient will awaken pain free. This therapy is an excellent option for patients who travel frequently and wish to avoid treatment for acute migraine.

Other procedurally oriented treatments, including botulinum toxin A injection, trigger point injection, occipital nerve block, and sphenopalatine ganglion block, have been used to treat migraine as well. These are considered second- or third-line therapies that can be tried when other treatments have failed. They can also be used in combination with other treatments if a patient has a specific migraine trigger. A complete discussion of these treatments, however, is beyond the scope of this article, as is the topic of migraine prevention.