Migraines are headaches that typically cause throbbing pain on one or both sides of the head and worsen with activity, according to the Mayo Clinic. Some patients have nausea, vomiting, sensitivity to light or noise or visual disturbances as well. Without treatment, the headache may last as long as 72 hours. Patients may learn to prevent headaches by avoiding migraine triggers such as wine, cheese, stress or flashing lights, or to take medication at the onset of the headache. If the migraine is severe and persistent, it's sometimes necessary to seek emergency room treatment.
Intravenous DHE
A patient with a severe migraine is likely to have nausea and vomiting so will not be able to tolerate medications by mouth. The treatment of choice in the emergency room is intravenous dihydroergotamine or DHE for pain and an anti-emetic for nausea and vomiting, according to Dr. Stephen D. Silberstein in a report published in the January 2000 issue of "Neurology." DHE plus an anti-emetic such as prochlorperazine or metoclopramide can abort very severe attacks, notes the Merck Manual. However, DHE is not suitable for patients with coronary artery disease or uncontrolled high blood pressure because it constricts the coronary arteries. DHE may relieve non-migraine headaches as well, so relief of the pain doesn't necessarily prove that it was a migraine.
Narcotics
Opiate analgesics--narcotic pain medications--can be habit-forming so are typically given only as a last resort when other medications have failed, the Merck Manual says. If given too often, they may also cause medication-overuse rebound headaches. Intravenous or intramuscular opiates such as meperidine, butorphanol or methadone should only be given in the emergency room or in situations in which the patient isn't at risk when sedated, according to Dr. Silberstein.
Ketorolac
Ketorolac is a potent NSAID--non-steroidal anti-inflammatory drug--that may be used in the emergency room treatment of migraine headaches, notes Dr. Silberstein, although more research must be done on its effectiveness. Ketorolac is not a narcotic and is not habit-forming. However, it's only approved by the U.S. Food and Drug Administration for short-term use--up to five days for adults--because it, like other NSAIDs, may cause such problems as a heart attack, stroke, gastrointestinal bleeding, ulcers, high blood pressure and other serious side effects, according to Drugs.com. Ketorolac is not suitable for patients with peptic ulcers, kidney failure or bleeding disorders and should not be given on a long-term basis.
