Send to

Choose Destination
Cephalalgia. 2015 Mar;35(3):271-84. doi: 10.1177/0333102414535997. Epub 2014 May 29.

Canadian Headache Society systematic review and recommendations on the treatment of migraine pain in emergency settings.

Author information

University of Ottawa, Canada Children's Hospital of Eastern Ontario, Canada
Montreal Neurological Institute, McGill University, Canada.
University of Calgary, Faculty of Medicine, Department of Clinical Neurosciences, Hotchkiss Brain Institute, Canada.
University of Calgary Faculty of Medicine, Departments of Clinical Neurosciences and Medical Genetics, Hotchkiss Brain Institute, Canada.
Department of Medicine, Division of Neurology, University of British Columbia, Canada.
Mayo Clinic College of Medicine, Department of Neurology, AZ, USA.
Associate Clinical Professor Hamilton Health Sciences, St Joseph's Healthcare Hamilton, Canada.
Sunnybrook Health Sciences Centre, The Hospital for Sick Children, University of Toronto, Canada.
Centre Hospitalier Universitaire de Montréal, Canada.
University of Ottawa, Canada.



There is a considerable amount of practice variation in managing migraines in emergency settings, and evidence-based therapies are often not used first line.


A peer-reviewed search of databases (MEDLINE, Embase, CENTRAL) was carried out to identify randomized and quasi-randomized controlled trials of interventions for acute pain relief in adults presenting with migraine to emergency settings. Where possible, data were pooled into meta-analyses.


Two independent reviewers screened 831 titles and abstracts for eligibility. Three independent reviewers subsequently evaluated 120 full text articles for inclusion, of which 44 were included. Individual studies were then assigned a US Preventive Services Task Force quality rating. The GRADE scheme was used to assign a level of evidence and recommendation strength for each intervention.


We strongly recommend the use of prochlorperazine based on a high level of evidence, lysine acetylsalicylic acid, metoclopramide and sumatriptan, based on a moderate level of evidence, and ketorolac, based on a low level of evidence. We weakly recommend the use of chlorpromazine based on a moderate level of evidence, and ergotamine, dihydroergotamine, lidocaine intranasal and meperidine, based on a low level of evidence. We found evidence to recommend strongly against the use of dexamethasone, based on a moderate level of evidence, and granisetron, haloperidol and trimethobenzamide based on a low level of evidence. Based on moderate-quality evidence, we recommend weakly against the use of acetaminophen and magnesium sulfate. Based on low-quality evidence, we recommend weakly against the use of diclofenac, droperidol, lidocaine intravenous, lysine clonixinate, morphine, propofol, sodium valproate and tramadol.


Migraine; acute pain; emergency; headache; management

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center