2025 guideline update to acute treatment of migraine for adults in the emergency department: The American Headache Society evidence assessment of parenteral pharmacotherapies
Rattachement africain : us, ca. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
OBJECTIVE: To update the 2016 American Headache Society (AHS) guideline on parenteral pharmacologic therapies for the management of migraine attacks in the emergency department (ED). METHODS: We conducted a systematic review and meta-analysis using the same methodology as the 2016 guideline. The original search strategy was repeated and expanded to include studies of nerve blocks and sphenopalatine ganglion (SPG) blocks. We searched Medline, Embase, Cochrane, clinicaltrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform through February 10, 2025. Eligible studies were randomized controlled trials (RCTs) involving adults diagnosed with migraine, treated in the ED with intravenous (IV), intramuscular (IM), subcutaneous (SC), or nerve block (including SPG block) interventions. Two reviewers independently screened titles/abstracts and full texts; a third reviewer resolved disagreements. Data were extracted using a standardized form and verified by a second reviewer. Risk of bias was assessed using the American Academy of Neurology (AAN) criteria. Where applicable, meta-analyses were performed. Efficacy was categorized as highly likely, likely, or possibly effective or ineffective. Clinical recommendations were developed using the AAN guideline development process. RESULTS: The search identified 26 new RCTs evaluating 20 injectable treatments. Of these, 12 were rated class I (low risk of bias), 9 class II, and 4 class III. Prochlorperazine IV, dexketoprofen IV, sumatriptan SC, and greater occipital nerve blocks (GONB) were considered highly likely to be effective based on multiple class I studies. Chlorpromazine IV, metoclopramide IV, eptinezumab IV, ketorolac IV, and supraorbital nerve blocks (SONB) were considered likely effective based on one class I or multiple class II studies. Hydromorphone IV, propofol IV, and paracetamol IV were considered likely ineffective based on class I or multiple class II studies. After review of the evidence and a consensus process, recommendations were made for each intervention. CONCLUSIONS: Prochlorperazine IV and GONB must be offered to eligible adults presenting to the ED with a migraine attack for treatment of headache requiring parenteral therapy (level A - must offer) in those without contraindications, while hydromorphone IV must not be offered (level A - must not offer). Treatments that should be offered when appropriate (level B - should offer) include dexketoprofen IV, ketorolac IV, metoclopramide IV, sumatriptan SC, and SONB. Chlorpromazine IV, dexamethasone IV, and valproate IV may be offered (level C - may offer). Paracetamol IV may not be offered (level C - should not offer). Eptinezumab should be offered (level B) only for patients matching the clinical trial population but is rated level U - no recommendation for an ED-specific population. Additional evidence is needed for caffeine, granisetron, ibuprofen, ketamine, lidocaine, normal saline, propofol, and SPG blocks, all currently rated level U - no recommendation.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- 2025 guideline update to acute treatment of migraine for adults in the emergency department: The American Headache Society evidence assessment of parenteral pharmacotherapies
- Date Crossref
- 01/12/2025
- Éditeur
- Wiley
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
-
Barrow Neurological Institute Department of Neurology pays non établi dans la noticeÉtablissement de santé
-
Dignity Health pays non établi dans la noticeÉtablissement de santé
-
NYU Langone Health Department of Neurology pays non établi dans la noticeÉtablissement de santé
-
Albert Einstein College of Medicine Department of Emergency Medicine Montefiore Medical Center pays non établi dans la noticeUniversité ou école supérieure
-
Montefiore Medical Center pays non établi dans la noticeÉtablissement de santé
-
University of Ottawa pays non établi dans la noticeUniversité ou école supérieure
-
Queensway-Carleton Hospital Department of Emergency Medicine pays non établi dans la noticeÉtablissement de santé
-
Ottawa Hospital Department of Emergency Medicine pays non établi dans la noticeÉtablissement de santé
-
Institut du Savoir Montfort pays non établi dans la noticeOrganisation à but non lucratif
-
CARE Canada pays non établi dans la noticeOrganisation à but non lucratif
-
University of Calgary Department of Clinical Neurosciences pays non établi dans la noticeUniversité ou école supérieure
-
Alberta Children's Hospital pays non établi dans la noticeÉtablissement de santé
Department of Neurology — Barrow Neurological Institute, Dignity Health et Department of Neurology — NYU Langone Health, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.