Migraine algo v1

  • Patient presents with headache
    • Pregnant?
      • Yes
        • Exit Algorithm
      • No
        • History and physical exam
          • Meets migraine headache criteria?
            • No
              • Proceed with non-migraine headache evaluation. Exit algorithm.
            • Yes
              • Mild headache?
                • Yes
                  • Tylenol (acetaminophen) PO or
                  • Ibuprofen PO or
                  • Sumatriptan PO or IN
                • No
                  • Moderate-severe headache
                    • Try
                      • Compazine (Prochlorperazine) IV and
                      • Normal saline fluid bolus and
                      • Toradol (Ketorolac) IV and
                      • Consider Dexamethasone IV
                    • Reassess in 60 minutes
                      • Improvement?
                        • Yes
                          • D/C with Naprosyn (Naproxen) for 3 days
                        • No
                          • Reassess in 60 minutes
                            • Improvement?
                              • Yes
                                • D/C with Naprosyn (Naproxen) for 3 days or
                                • If good response to DHE, consider D/C with triptan (to be started 24 hours after DHE dose in ED)
                              • No
                                • Dihydroergotamine (DHE) or Valproate IV
                                  • Improvement?
                                    • Yes
                                      • D/C with Naprosyn (Naproxen) for 3 days or
                                      • If good response to DHE, consider D/C with triptan (to be started 24 hours after DHE dose in ED)
                                    • No
                                      • Consult Neurology; consider admission

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