The Skeptics Guide to Emergency Medicine SGEM Xtra: Hit Me with Your Best Block – 2025 AHS ED Migraine Guidelines
Jan 10, 2026
Jennifer Robblee, a board-certified neurologist and headache specialist, joins forces with Serena Orr, a pediatric neurologist, to discuss the latest 2025 guidelines on migraine treatments in emergency settings. They dive into the necessity for updates due to new evidence and ongoing practice variations. The duo emphasizes effective treatments like prochlorperazine and greater occipital nerve blocks, while warning against the use of hydromorphone. They also tackle practical implementation challenges and the need for more patient-centered research in headache management.
AI Snips
Chapters
Transcript
Episode notes
A Simple Family Doc Fixed A Medical Student Migraine
- Ken Milne described his sole migraine in medical school and how a family doctor diagnosed and treated it simply with NSAIDs, antiemetic, and rest.
- He credits that pragmatic approach for resolving his attack and shaping his view of migraine care.
Make Prochlorperazine Or GONB First-Line
- Offer IV prochlorperazine or a greater occipital nerve block as first-line options for adult ED migraine patients when appropriate.
- Consider adding dexamethasone and an IV NSAID if using IV therapy, and offer bilateral GONB for broad applicability.
Stop Routinely Giving Hydromorphone
- Avoid using hydromorphone for ED migraine treatment except in exceptional circumstances after shared decision-making.
- Recognize opioids increase return visits, risk medication-overuse headache, and have poorer efficacy versus alternatives.