Updated Guidelines for Managing Migraine in the ED

Clinical Takeaway

: Intravenous prochlorperazine and greater occipital nerve blocks emerged as first-line interventions.

An overview of the 2025 Guideline Update to Acute Treatment of Migraine for Adults in the Emergency Department: The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies

Background

Severe headache and migraine are leading causes of emergency department (ED) presentations. During the past 10 years, more than 25 clinical trials on parenteral migraine therapies have been published, prompting the American Headache Society to release updated guidelines on adult migraine management in the ED. The guidelines are based on systematic review and meta-analysis, with expert discussion and consensus as needed. They include not only intravenous (IV) and subcutaneous (SC) medications but also nerve blocks. Recommendations for each in…

Reviewing Author

Teshamae Monteith, M.D.

Disclosures

Consultant/Advisory BoardAbbVie; Axsome; Teva; Linpharma; e-Neura; Novartis; Merz; Lundbeck; Axsome; Pfizer. Unpaid co-author for collaborative research sponsored by AbbVie, Pfizer/Biohaven, and Theranica.

RoyaltiesSpringer

Editorial BoardsCephalalgia; Continuum Audio; Neurology Minute; Neurology; American Migraine Foundation; Brain and Life Magazine

Leadership Positions in Professional SocietiesFlorida Society of Neurology (member, Executive Board); American Migraine Foundation (member, Executive Board); United Councils of Neurologic Subspecialities Examination Committee (Vice Chair)

OtherPaid speaking/education for Medscape, Massachusetts Medical Society, American Headache Society, and American Academy of Neurology