Mount Carmel Health Partners Clinical Guidelines Migraine | Page 2

Treatment for Acute Migraine Headache
Mild: Patient is aware of
headache but is able to continue
daily activities; without nausea
or vomiting
Moderate: Headache
inhibits daily activities but is not
incapacitating; associated with
severe nausea or vomiting
Treatment:
• acetaminophen/aspirin/
caffeine orally
OR
• ibuprofen 400mg-600mg
orally if no contraindications OR
• aspirin 975mg orally if no
contraindications
OR
• sumatriptan 100mg
orally or 6mg subcutaneously
Headache
resolved?
Treatment:
• ketorolac 15-30mg IV
• diphenhydramine 25mg IV
AND
• prochlorperazine 10mg IV
OR
• metoclopramide 10mg IV
• consider dexamethazone
10 mg IV
AND
• IV fluids
No
Severe: Headache is
incapacitating
Treatment:
• consider moderate HA
treatment options
• sumatriptan 6mg
subcutaneously
AND
• ketorolac 15-30mg IV
• consider dexamethazone
10mg IV
AND
• IV fluids
Headache
resolved?
Headache
resolved?
No
No
Yes
Yes
Yes
Add opioid (e.g.,
dilaudid,
fentanyl, nubain,
morphine)
Consider prophylactic
treatment and/or referral to a
headache specialist if indicated
Progress to
treatment for
moderate
headache
Yes
• redose neuroleptic
• add opioid
• consider triptan
Headache
resolved?
Evaluation
No
Treatment
Progress to treatment
for severe headache
Migraine - 2
Yes
Headache
resolved?
No
Immediate referral to a
headache specialist
and reevaluate for
other
causes of headache