Written by Clay Smith
A bolus of IV normal saline did not improve pain control in patients with migraine headache beyond usual treatment with IV prochlorperazine + diphenhydramine.
Why does this matter?
Saline boluses are often given to help migraine patients. Many are volume depleted due to nausea, poor fluid intake, or vomiting. We know dehydration enhances perception of pain. So, how effective is NS as a treatment for migraine-related pain?
What doesn’t help a migraine
This was a small pilot RCT with 50 patients randomized to receive 1L of NS over 60 minutes vs 10mL/hr over 60 minutes plus usual treatment for all with IV prochlorperazine + diphenhydramine. Pain on a 0-10 scale at 60 minutes dropped 4.5 points in the fluid group and 4.9 in the no-fluid group, which was not statistically different. Keep in mind, this study was small and meant to be exploratory. They also were very choosy in patient selection, with 413 patients excluded for failing to meet the third International Classification of Headache Disorders definition of migraine. It indicates that IV fluid did not help relieve pain from migraine. However, many patients with migraine also have nausea or vomiting. So, use of IV fluid may still be helpful for patients in other ways. But as a pain reliever, it appears ineffective.
Intravenous Fluid for the Treatment of Emergency Department Patients With Migraine Headache: A Randomized Controlled Trial. Ann Emerg Med. 2019 Feb;73(2):150-156. doi: 10.1016/j.annemergmed.2018.09.004. Epub 2018 Oct 26.
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Reviewed by Thomas Davis