How is inpatient care used to help break the cycle of chronic migraine?
Inpatient care for the treatment of chronic migraine usually involves a combination of a variety of medications including IV forms of DHE, antinausea medications, toradol, magnesium, and lidocaine.
“Inpatient care is for the worst. The situation where somebody is about to lose their job or drop out of school or is just at the end of their rope and their disability is progressing and the pain is progressing.
“We bring people in in an urgent but not emergent way. It depends on what kinds of medicines have worked for them. The oldest proven treatment is IV DHE. That's still 20 years later, 30 years later actually, the standard with one of the IV nausea medicines, such as metoclopramide or chlorpromazine, or even haloperidol or promethazine. Then we sometimes supplement that with toradol. We sometimes supplement it at Jefferson with intravenous lidocaine. That's usually how we start. Not everything is safe for everyone, so we have to individualize that. Many will also receive some IV magnesium. There's some evidence to support that.”
Inpatient care is usually a last resort when other forms of treatment have failed to break the chronic migraine cycle. The specific combination of drugs used in a hospital setting will vary but usually consists of a combination of pain and antinausea medications given intravenously. Some physicians might also give magnesium intravenously. Pain medications that are often used are dihydroergotamine (DHE), toradol, and lidocaine. Antinausea medications that are often used are metoclopramide, chlorpromazine, and promethazine.
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William B. Young, MD
Neurologist and Headache Specialist
Jefferson Headache Center
Dr. William Young is a world-renowned pioneer in the field of migraine. He serves as the director of the Jefferson Headache Center in Philadelphia. He instructs neurologists on headache medicine and regularly publishes research on the topic. He is board-certified in neurology, psychiatry, and headache medicine. Dr. Young is a passionate advocate on eradicating the stigma of migraine. He fights on Capitol Hill for greater funding and research on migraine. In addition to his roles at the American Headache Society and the American Academy of Neurology, he is also president of the Alliance for Headache Disorders.