• Migrane SSOU Admission Guideline

    Definition

    Migraine similar to previously established clear diagnosis but not responding to usual treatment

    Admission Criteria

    • Clear diagnosis, ie: similar recurrent headache in past diagnosed as migraine
    • Previous normal CT
    • Long established history of migraine
    • Requires IV hydration
    • Requires treatment

     

    Exclusion Criteria

    • Fever, unless there is a clear non-CNS focus
    • Impaired consciousness level (GCS < 14)
    • New focal neurological deficits
    • sudden onset of headache indicating SAH

     

    Investigations

    Aimed at excluding SAH, tumour, meningitis. These conditions may be excluded clinically in many cases.

    Consider:

    • FBE
    • UEC
    • CTB
    • ESR
    • LP

     

    Suggested Medications

     
     Drug  Dose  Frequency  Route 
     Normal Saline   1L-2L   to rehydrate  IVI 
     Aspirin (+/- codeine)  900mg  4 hourly  oral 
     Maxolon  10-20mg  6/24  IV 
    Chlorpomazine12.5-25mg in 1000mL NSalineOnce over 1 hourIVI
    Sumitriptan50-100mgOnceOral or Intranasal
    Dihydroergotamine0.5-1mgonceslow IV
    Magnesium should be considered if migraine linked to menstrual cycle

     

    Specific Observations

    • Report drop in GCS by 1 point
    • Headache/vomiting not controlled with maximal treatment
    • Report new onset fever

     

    Specific Management Issues

     

    Discharge Criteria

    • Pain free and controlled by oral analgesia
    • Normal hydration
    • Vomiting ceased
    • Adequate social supports
    • Diagnosis certain

     

    Hospital Admission Criteria

    • Headache not controlled by oral analgesia
    • Development of new neurological deficit or failure of brief neurological deficit to resolve
    • Impaired level of consciousness
    • Poor social supports
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