Key Clinical Issue: What are the comparative benefits and adverse effects of parenteral treatments for adults who present to the emergency department with migraine headaches? Evidence-Based Answer: Parenteral sumatriptan, metoclopramide, neuroleptics, and nonsteroidal anti-inflammatory drugs (NSAIDs) effectively reduce or eliminate migraine headache pain within two hours. (Strength of recommendation [SOR]: A, based on consistent, good-quality patient-oriented evidence.) Droperidol may provide complete relief better than prochlorperazine. (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.) Migraine recurrence is less likely in patients receiving dexametha-sone with abortive therapy. Most adverse effects are minor and self-limiting; however, akathisia is associated with neuroleptics and metoclopr amide.
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