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Acute Migraine Treatment in Emergency Settings [Internet]

Acute Migraine Treatment in Emergency Settings [Internet]

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US)

Version: November 2012

Summary and Discussion

This comparative effectiveness review (CER) report provides a comprehensive synthesis of the evidence on the comparative effectiveness of parenteral pharmacological interventions versus standard care, placebo, or an active treatment in the treatment of acute migraine headaches in adults visiting the emergency department (ED) or an equivalent setting. The strength of the body of evidence for key effectiveness outcomes is summarized by intervention below.

Executive Summary

Migraine is a chronic neurovascular disorder characterized by dysfunction of the central and peripheral nervous systems and intracranial vasculature. Acute exacerbations of episodic and chronic migraine cause severe and disabling pain that often results in visits to an emergency department (ED), as well as decreased productivity and missed time from work, school, and other activities. Migraine has a negative impact on overall quality of life and is associated with psychiatric and medical comorbidities., In the United States, migraine and related medical issues result in costs of more than $13 billion per year due to lost productivity.


This chapter reports on the results of the literature search and evidence synthesis. First, the results of the literature searching, selection process, and a summary of the study characteristics and methodological quality of the included studies are described. The results of analyses are presented by Key Question (KQ). We present the results of the comparative effectiveness of parenteral pharmacological interventions versus placebo, standard care, or active agents ( and ). These results are organized by drug class (e.g., neuroleptics, opioids) and then are grouped by placebo-controlled studies or direct head to head comparisons of drugs or combinations of drugs. The adverse effect results () are organized by categories of adverse effects (e.g., sedation, nausea/vomiting) and then subgrouped by drug class. This is followed by results for the specific side effect, akathisia (). Results related to subpopulations ( and ) appear at the end of this chapter.


Migraine is a chronic neurovascular disorder characterized by dysfunction of central and peripheral nociceptive pathways and intracranial vasculature. Migraine is characterized by a moderate to severe, recurrent, unilateral or bilateral, throbbing headache that can last hours to days. It may be accompanied by nausea, vomiting, and sensitivity to light, sound, touch, and/or smell. Approximately 25 percent of people with migraine experience transient visual disturbance, motor symptoms, or language disturbance., The triggers of migraine headaches are multi-factorial, and the pathophysiology is complex and incompletely understood. Current research suggests that migraines occur as a result of a cascade of events involving activation of the trigeminovasucalar system, cortical spreading depression, and neuronal sensitization. Ongoing research in migraine genetics indicates that there may be a genetic disposition to migraine.


The methods section reflects the protocol that was developed a priori as part of the topic development and refinement stages of this comparative effectiveness review (CER).

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