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Does IV Fluid Help Treat Headache?

August 14, 2020

Written by Aaron Lacy

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In patients who presented to the ED with primary headache, those who received IV fluid had similar reduction in pain compared to those who did not.

Why does this matter?
We covered a small RCT that showed no difference in pain control with IV fluid. While low risk, adding IV fluids as part of a headache “cocktail” may add time and expense to emergency department visits for primary headache. Does fluid make a difference?

Vodka martini: shaken, not stirred – and without the fluids
This single-center, blinded, clinical trial randomized 58 patients aged 10-65 with primary headaches to receive prochlorperazine and diphenhydramine with or without an IV fluid bolus. On a 100mm visual analog scale, 35 patients who received a 20mL/cc (up to 1000mL) normal saline bolus had a 48.3mm reduction in pain at 60 minutes. The 23 patients randomized to the control group, 5mL of saline over 60 minutes, had a 48.7mm reduction in pain at the same time interval. There was no statistical (0.4mm, 95% CI -16.5-17.3, p=0.96) or clinical (pain score change >13mm) difference between these groups, raising the question of whether IV fluid should be used in patients with primary headache.

This study was small and underpowered, but shows similar results to prior studies asking the same clinical question. I include fluids in my headache cocktail, but maybe only because it makes me feel like I am doing more for the patient. I will have to reevaluate whether or not this is a good use of resources the next time I sign up for a patient with headache.

I-FiBH trial: intravenous fluids in benign headaches-a randomised, single-blinded clinical trial. Emerg Med J. 2020 Jul 3. pii: emermed-2019-209389. doi: 10.1136/emermed-2019-209389. [Epub ahead of print]

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What are your thoughts?