What is your first-line therapy for acute migraine treatment in the ER?

Regarding the abortive and preventive treatment of migraine, in the office or ER, we should focus on migraine-specific medications. These are the ergots, triptans, and gepants abortively, and the CGRP antibodies and gepants preventively. The patients who visit ERs every so often tend to have headach...

I would still use ketorolac 30 mg IV + prochlorperazine 10 mg IV + diphenhydramine 25 mg IV (mainly to decrease akathisia side effects of prochlorperazine). Would add Dexamethasone IV due to the evidence of decreasing the risk of headache recurrence. Then, as a second line in no particular order, wo...

When guidelines are based on well-done, randomized trials, I tend to pay more attention to them. The most recent 2025 guidelines for treatment of migraine in the ER, first author Dr. @Dr. First Last, are excellent. Giving IV prochlorperazine cautiously may be a good start. Depending on the timing of...