Topic: Migraine and Emergency Medicine
Host: Mia Minen, MD, MPH, FAAN, FAHS [@MiaMinenMD]
Guest: Benjamin W. Friedman, MD, MS [@benjaminbwf]
Description: When migraine or headache pain is at its peak and usual treatments aren’t effective, patients often turn to the emergency department for relief. In some cases, this may be the most appropriate choice—especially when headache red flags are present. However, limited access to care, treatments or education often causes patients to make unnecessary trips to the ED. What are some headache red flags that warrant referring to the ED? What treatments are administered to patients with migraine who come to the ED? What can be done to help patients avoid returning to the ED? We cover these questions and others with Benjamin W. Friedman, MD, MS, an emergency physician and clinical epidemiologist in the department of emergency medicine at the Albert Einstein College of Medicine.
[02:02] What are some headache red flags that should prompt someone to visit the emergency department?
[04:00] Are there specific circumstances or factors, such as with pregnant or older patients, that should prompt someone to go to the emergency department for headache?
[05:37] What treatments are given to patients with migraine who come to the emergency department? Does the American Headache Society have guidelines for deciding which medications to use?
[08:40] What should health care providers know about using metoclopramide and prochlorperazine to treat patients with migraine?
[10:17] If patients in the emergency department don’t respond to the top evidence-based treatments, what other treatment methods can be offered to them?
[13:34] Do opioids have a role in managing headache or migraine in the emergency department?
[15:52] How can emergency clinicians improve their approach when it comes to migraine?
[16:38] What can be done to help patients from returning to the emergency department?
Learn more about the American Headache Society’s First Contact - Headache in Primary Care program at https://americanheadachesociety.org/primarycare/, check out our Acute Treatment for Migraine page for more on rescue medications at https://americanheadachesociety.org/topic/acute-treatment/ and follow us on Twitter (@ahsheadache).