title: Canadian Headache Society systematic review and recommendations on the treatment of migraine pain in emergency settings.
abstract: BACKGROUND
  There is a considerable amount of practice variation in managing migraines in emergency settings, and evidence-based therapies are often not used first line.
  
  
  METHODS
  A peer-reviewed search of databases (MEDLINE, Embase, CENTRAL) was carried out to identify randomized and quasi-randomized controlled trials of interventions for acute pain relief in adults presenting with migraine to emergency settings. Where possible, data were pooled into meta-analyses.
  
  
  RESULTS
  Two independent reviewers screened 831 titles and abstracts for eligibility. Three independent reviewers subsequently evaluated 120 full text articles for inclusion, of which 44 were included. Individual studies were then assigned a US Preventive Services Task Force quality rating. The GRADE scheme was used to assign a level of evidence and recommendation strength for each intervention.
  
  
  CONCLUSIONS
  We strongly recommend the use of prochlorperazine based on a high level of evidence, lysine acetylsalicylic acid, metoclopramide and sumatriptan, based on a moderate level of evidence, and ketorolac, based on a low level of evidence. We weakly recommend the use of chlorpromazine based on a moderate level of evidence, and ergotamine, dihydroergotamine, lidocaine intranasal and meperidine, based on a low level of evidence. We found evidence to recommend strongly against the use of dexamethasone, based on a moderate level of evidence, and granisetron, haloperidol and trimethobenzamide based on a low level of evidence. Based on moderate-quality evidence, we recommend weakly against the use of acetaminophen and magnesium sulfate. Based on low-quality evidence, we recommend weakly against the use of diclofenac, droperidol, lidocaine intravenous, lysine clonixinate, morphine, propofol, sodium valproate and tramadol.
authors.affiliation: University of Ottawa, Canada Children's Hospital of Eastern Ontario, Canada sorr@cheo.on.ca.
authors.forename: Serena L
authors.initials: SL
authors.lastname: Orr
authors.affiliation: Montreal Neurological Institute, McGill University, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Aubé
authors.affiliation: University of Calgary, Faculty of Medicine, Department of Clinical Neurosciences, Hotchkiss Brain Institute, Canada.
authors.forename: Werner J
authors.initials: WJ
authors.lastname: Becker
authors.affiliation: University of Calgary Faculty of Medicine, Departments of Clinical Neurosciences and Medical Genetics, Hotchkiss Brain Institute, Canada.
authors.forename: W Jeptha
authors.initials: WJ
authors.lastname: Davenport
authors.affiliation: Department of Medicine, Division of Neurology, University of British Columbia, Canada.
authors.forename: Esma
authors.initials: E
authors.lastname: Dilli
authors.affiliation: Mayo Clinic College of Medicine, Department of Neurology, AZ, USA.
authors.forename: David
authors.initials: D
authors.lastname: Dodick
authors.affiliation: Associate Clinical Professor Hamilton Health Sciences, St Joseph's Healthcare Hamilton, Canada.
authors.forename: Rose
authors.initials: R
authors.lastname: Giammarco
authors.affiliation: Sunnybrook Health Sciences Centre, The Hospital for Sick Children, University of Toronto, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gladstone
authors.affiliation: Centre Hospitalier Universitaire de Montréal, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Leroux
authors.affiliation: Centre Hospitalier Universitaire de Montréal, Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Pim
authors.affiliation: University of Ottawa, Canada.
authors.forename: Garth
authors.initials: G
authors.lastname: Dickinson
authors.affiliation: University of Ottawa, Canada.
authors.forename: Suzanne N
authors.initials: SN
authors.lastname: Christie
mesh_terms: D002170:Canada / Q000453:epidemiology; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D006801:Humans; D008881:Migraine Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D059408:Pain Management / Q000379:methods / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000592:standards; D012955:Societies, Medical / Q000592:standards*; D016896:Treatment Outcome
keywords: Migraine; acute pain; emergency; headache; management