IV Treatment of Refractory Migraines

High Success Rate in the Clinic

by Dr. John Claude Krusz and Teri Robert, Lead Expert


Refractory Migraines — Migraines that are not responding to treatment — can present significant issues for Migraineurs, including status migrainosus. Dr. John Claude Krusz has been working toward more effective treatments for such headaches and Migraines and has found several IV treatments that are extremely successful. Some doctors are not aware of them, or even if they’re aware of them, may not be set up to administer them. In such cases, these treatments may be administered outpatient at a hospital, sometimes through the emergency department. The information below was presented at the 49th Annual Scientific Meeting of the American Headache Society.


Our primary objective is to demonstrate the high efficacy of IV treatment of refractory (resistant to or not responding to treatment) Migraines and headaches, and pain flareups in the clinic. We have used this method of treatment as a primary treatment modality in our headache clinic for a number of years with a high degree of success.


Aggressive headache treatment belongs in the specialty clinic, with greater cost- and time-effectiveness treating intractable headaches and Migraines. Compared with the Emergency Department [ED], the outpatient headache clinic can offer a wider range of treatments and thus maximum success. We have used IV treatment in the clinic since 1994 and presented initial data regarding effectiveness in 1998. This study continues documenting degree of success of outpatient IV treatment of headaches.


  • Total treated patients number over 2,500, and 1,074 were treated exclusively for refractory Migraines/headaches.
  • Approximately 1,000 patients had mixed headache and pain flareups that were treated in the clinic.
  • We utilized, either alone or in combinations:
    • magnesium sulfate
    • dexamethasone (brand name Decadron)
    • valproate sodium (brand name Depacon)
    • droperidol (brand name Inapsine)
    • metochlopramide (brand name Reglan)
    • dihydroergotamine brand name DHE45
    • promethazine (brand name Phenergan)
    • lidocaine
    • propofol
    • tramadol (brand name Ultram)
    • levetiracetam (brand name Keppra)
    • ketamine
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