{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T22:30:46Z","timestamp":1762900246093,"version":"build-2065373602"},"reference-count":42,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,11,22]],"date-time":"2021-11-22T00:00:00Z","timestamp":1637539200000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Millions of patients present to US emergency departments (ED) annually for the treatment of migraine. First\u2010line treatments, including metoclopramide, prochlorperazine, and sumatriptan, fail to provide sufficient relief in up to one\u2010third of treated patients. In this narrative review, we discuss the evidence supporting the use of injectable (intravenous, intramuscular, or subcutaneous) medications for patients in the ED who fail to improve sufficiently after treatment with first\u2010line medication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used the American Headache Society's guideline, \u201cManagement of Adults with Acute Migraine in the Emergency Department: The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies,\u201d published in 2016, to identify first\u2010line medications for migraine. We then conducted a PubMed search to determine whether any evidence supported the use of these medications as second\u2010line therapy and whether any evidence existed to support the use of injectable therapies not discussed in the guideline as second\u2010line therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified only scant high\u2010quality randomized data of second\u2010line therapy. Therefore, we based our recommendations on medications that have reliably demonstrated efficacy as first\u2010line treatment of migraine. These medications include injectable non\u2010steroidal anti\u2010inflammatory drugs (NSAIDs) and acetaminophen. Dihydroergotamine and valproic acid have some data supporting efficacy. More recently, greater occipital nerve blocks (GONBs) have been shown to be efficacious. With the exception of meperidine, opioids have been shown to be not efficacious. Most data published to date demonstrate no role for propofol and ketamine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There are no evidence\u2010based second\u2010line treatments of migraine in the ED setting. For patients with migraine, who fail to improve after treatment with a first\u2010line medication, it is reasonable to use an intravenous NSAID or intravenous acetaminophen. Alternatively, clinicians adept at performing a GONB may offer this treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.14239","type":"journal-article","created":{"date-parts":[[2021,11,22]],"date-time":"2021-11-22T05:25:47Z","timestamp":1637558747000},"page":"1467-1474","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Second\u2010line interventions for migraine in the emergency department: A narrative review"],"prefix":"10.1111","volume":"61","author":[{"given":"Farnam","family":"Kazi","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Medical Center  Bronx New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mallika","family":"Manyapu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Medical Center  Bronx New York 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