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Canadian Headache Society systematic review and recommendations on the treatment of migraine pain in emergency settings

Methodology Score: 3.5/5                
Usefulness Score: 4/5

Orr SL, et al.
Cephalalgia. 2014 May 29.

This Canadian Headache Society guideline for ED management of acute migraine gave a strong recommendation for 5 treatments: ketorolac, metoclopramide, sumatriptan (if presenting within 2 hours), prochlorperazine and lysine-ASA (the latter 2 are unavailable in Canada). Despite some concerns about lack of appropriate stakeholders and external review, JC attendees agreed with the recommendations that dihydroergotamine should be considered for rescue therapy whereas corticosteroids and opioids for acute pain relief should be avoided.  
By: Dr. Krishan Yadav
(Presented February 2015)

Epi Lesson: AGREE-II Tool for Evaluation of Clinical Practice Guidelines
Clinicians frequently use clinical practice guidelines (CPGs) to inform their practice. Often these also form standards of care. It is important to critically appraise CPGs as you would other articles in the literature. One helpful, user-friendly tool is the AGREE-II instrument. Using this tool takes you through the appropriate steps of CPG development and dissemination and allows you to evaluate for important sources of bias such as appropriate stakeholder involvement and external review. 
By: Dr. Lisa Calder


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