Research Activities January 2013, No. 389

Many non-oral medications appear to effectively treat acute migraines in emergency department patients

Comparative Effectiveness Research

Many non-oral agents, such as nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and triptans, appear to be effective for treating acute migraine headache when compared to placebo for patients seeking treatment at the emergency department. However, the strength of evidence is not sufficient to show any one treatment is better than another, according to a recent review of the evidence by the Agency for Healthcare Research and Quality (AHRQ).

The review compares the effectiveness of non-oral medications versus standard care, placebo, or other treatments for acute migraine headaches in patients who seek treatment at an emergency department. Nine different classes of drugs are reviewed: antiemetics (metoclopramide), neuroleptics, ergotamines, NSAIDs, opioids, corticosteroids, triptans, magnesium sulfate (MgSO4), and antihistamines.

Intravenous systemic corticosteroids were found to be effective for preventing headache recurrence up to 72 hours after discharge, especially in patients with prolonged headaches. The report also discussed that adverse event reporting is not consistent across trials. Therefore, there is not enough evidence to compare adverse events among different treatments. More research is required to identify the most effective non-oral treatments for adults with acute migraine in an emergency setting.

Acute migraine is a debilitating condition caused by dysfunction of the central and peripheral nervous systems and intracranial vasculature. Episodes of migraine cause severe and disabling pain that often results in visits to an emergency department 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 in the United States, migraine and related medical issues result in costs of more than $13 billion per year in lost productivity.

These findings are available in the research review Acute Migraine Treatment in Emergency Settings. You can read this review and other reports from AHRQ's Effective Health Care Program at

Page last reviewed January 2013
Page originally created January 2013
Internet Citation: Many non-oral medications appear to effectively treat acute migraines in emergency department patients. Content last reviewed January 2013. Agency for Healthcare Research and Quality, Rockville, MD.