Check U+Es, LFTs, Mg++
Quiet dark single room
Avoid caffeine
Monitor observations 2 hourly (sedation)
Watch for opioid withdrawal (mainly codeine): alcohol withdrawal chart observations
Cease opioids, triptans, ergots
IV hydration Hartmann’s 80 mls/hr
IV ketamine infusion 200 mg: ketamine in 200 mls 5% dextrose 5-10 mg/hr; start at 5 mg/hr
IV dexamethasone 6 mg daily
IV maxolon 10 mg QID regular
Continue usual headache/migraine preventive medications including topiramate
Consider pizotifen 4 mg tds po
Vitamin B2 (riboflavin) 100 mg bd po
Magnesium 500 mg daily po
Cefaly cranial TENS machine, 20 minutes 2 x daily prn, and regularly for 20 min at night
Bilateral GON blocks (ropivacaine 0.75%, kenacort 15 mg & clonidine 25 mcg each side)
Memantine 5-10 mg nocte po (to replace ketamine)
Intranasal oxytocin 10 IU QID prn
IV parcetamol 1g 6/24 prn first line headache
IV parecoxib 40 mg bd prn second line headache
Clonidine 50 mcg 6/24 prn po for anxiety, withdrawal or headache (withhold if sedated; HR<60, SBP< 110)
Lorazepam 0.5 mg 8/24 bd prn s/L for anxiety, withdrawal, severe nausea (withhold if sedated)
IV ondansetron 4 mg 6/24 prn for nausea & vomiting
General educational advice only. No responsibility taken for effects of this information.
EJ Visser 2018 ©