Evaluation and Treatment of Migraine in the Emergency Department: A Review


  • Mia T. Minen MD, MPH,

    Corresponding author
    1. Graham Headache Center, Department of Neurology, Brigham and Women's Faulkner Hospital, Boston, MA, USA
    2. Harvard Medical School, Boston, MA, USA
    • Address all correspondence to M.T. Minen, 1153 Centre Street, Suite 4970, Boston, MA 02130, USA; email: minenmd@gmail.com.

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  • Kaloyan Tanev MD,

    1. Harvard Medical School, Boston, MA, USA
    2. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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  • Benjamin W. Friedman MD, MS

    1. Department of Emergency Medicine, Montefiore Medical Center, Bronx, NY, USA
    2. Albert Einstein College of Medicine, Bronx, NY, USA
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  • Conflict of Interest: None.
  • There was no financial support for the research.


Head pain is the fifth most common reason for emergency department (ED) visits. It is second only to focal weakness as the most common reason for neurological consultation in the ED. This manuscript reviews how patients with migraine, the most common primary headache disorder for which patients seek medical treatment, are managed in the ED. We discuss existing guidelines for head imaging in patients with migraine, recommended pharmacologic treatments, and current treatment trends. We also review studies evaluating the discharge care of migraine patients in the ED. With the goal of standardizing, streamlining, and optimizing ED-based migraine care, we offer ideas for future research to improve the evaluation, treatment, and discharge care of patients who present to an ED with acute migraine.