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Paper Chase 3 – IV Fluids For Migraine

Sanjay Arora, MD and Mike Menchine, MD
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03:56
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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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00:47

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EM:RAP 2016 October Written Summary 754 KB - PDF

In the treatment of migraine headaches, the authors of this study found no short or long-term benefits to the addition of IV fluid to metoclopramide therapy.

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Paul B., M.D. -

Agree not all migraine headache patients need IVF.

However, I don't think this study proves the converse, that IVF is never needed in headache. From my review, they gave IVF indiscriminately to migraine patients and said it had no benefit on overall treatment.

A targeted decision to give IVF to those who are dehydrated or with a history of vomiting seems more reasonable approach to this question.

This study fails to cohort patients based on presence of vomiting, which is common in multiple headache syndromes.

Also, the decision to give IVF was at the discretion of the treating ED physician. There was no identification of a patient cohort determined to be dehydrated, by either judgment, labs, physical exam, or history of vomiting. They note aura and nausea but those wouldn't be my triggers to give IVF or not.

The study even clarifies in the discussion: "Therefore, clinicians should be sure to differentiate migraine from water deprivation headache and other secondary headaches that may respond to IVF". I've never diagnosed water deprivation headache outside of telling a patient they're probably hung over.

Seems like a better study could be done to answer this question of whether IVF has a role in headache management.

Virgil D., M.D. -

If one argues there is no selection bias in this analysis, then the fact that 66% of patients receiving IVF's had nausea vs 58% of those not receiving IVF would mean that IVF cause nausea. (i.e. if not selection bias then it would have to be causal). Alternatively the fact that there is a significant difference between groups could instead provide a pretty strong suggestion that the groups are indeed not similar and even suggest that the group receiving IVF, with a higher incidence of nausea, likely had different or worse disease. Thus making the conclusion that there was no advantage to IVF highly questionable.

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Say Hello to BRUE Full episode audio for MD edition 217:39 min - 303 MB - M4AEM:RAP 2016 October German Edition Deutsche 115:41 min - 159 MB - MP3EM:RAP 2016 October Canadian Edition Canadian 10:10 min - 14 MB - MP3EMRAP 2016 October Résumé en Francais Français 35:33 min - 49 MB - MP3EM:RAP 2016 October Aussie Edition Australian 31:48 min - 44 MB - MP3EM:RAP 2016 October Spanish Edition Español 94:36 min - 130 MB - MP3EM:RAP 2016 October Board Review Answers 187 KB - PDFEM:RAP 2016 October Board Review Questions 292 KB - PDFEM:RAP 2016 October MP3s 257 MB - ZIPEM:RAP 2016 October Written Summary 754 KB - PDF

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