Highlights of the 5th Annual Association of Family Practice Physician Assistants (AFPPA) Conference: Headache Management -- Evaluation and Treatment

San Antonio, Texas; November 19-23, 2003

Jim Meeks, PA-C

Disclosures

February 12, 2004

In This Article

Rescue Intervention

Various rescue medications can be used in the event of failure of triptan treatment for migraine headache. Schuman[1] discouraged use of meperidine due to its short half-life, potential neurotoxicity, and other limitations, stating that morphine sulfate is a better choice of an opioid. He also offered several alternatives -- his self-proclaimed favorite is diphenhydramine 20-50 mg IV push (IVP), followed by prochlorperazine 5-10 mg IVP.

Other options reviewed included:

  • ketorolac 60 mg IM or 30 mg IVP;

  • dihydroergotamine 1 mg IV, IM, or SQ;

  • metoclopramide 10 mg IV;

  • hydroxyzine 50 mg IM and dexamethasone 20 mg IM;

  • morphine sulfate 10 mg IM (dose range is 5-20 mg per dose); and

  • sodium valproate 500 mg IV.

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