Post by Dr Meghanath Yenni

Updated Migraine Management in the Emergency Department (2025 AHS Guideline Update): Acute migraine remains one of the most common neurological emergencies presenting to the ED. The American Headache Society (AHS) has updated its recommendations based on new evidence from more than 25 clinical trials evaluating parenteral therapies. Key practice updates: • IV prochlorperazine is now the preferred first-line ("must-offer") pharmacological treatment for eligible patients. • Greater occipital nerve block (GONB) is also a must-offer intervention, reflecting strong evidence for efficacy with minimal systemic adverse effects. • Also recommended ("should offer"): IV ketorolac IV metoclopramide Subcutaneous sumatriptan Supraorbital nerve block • IV prochlorperazine is now preferred over IV metoclopramide when an antidopaminergic agent is appropriate. • Diphenhydramine should not be used as migraine treatment alone, but it remains useful as premedication to reduce extrapyramidal adverse effects from dopamine antagonists. • Avoid IV hydromorphone. Evidence against opioid use has strengthened further, and it should no longer be part of routine ED migraine management. • Eptinezumab is a promising emerging option because of its rapid onset, but current evidence is insufficient for routine ED use. The updated guideline reinforces a shift toward evidence-based, non-opioid migraine management, with IV prochlorperazine and greater occipital nerve block emerging as the preferred first-line interventions for adults presenting to the emergency department. Source: Robblee J, et al. 2025 Guideline Update to Acute Treatment of Migraine for Adults in the Emergency Department: The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies. Headache. 2026;66:53. doi:10.1111/head.70016. #Migraine #EmergencyMedicine #Neurology #Headache #EvidenceBasedMedicine