IV Treatment of Refractory Migraines

by Teri Robert Patient Advocate

High Success Rate in the Clinic


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


Results are measured by successful resolution of symptoms, defined by at least a 50% decrease in severity of the presenting headache/Migraine, or by return to work/regular activity. Only 62 patients from the total pool, and 22 from the headache pool (2%) had unsuccessful treatment that required re-treatment in the clinic, hospital ED or inpatient admission. This represents a 98% rate of effective treatment in the clinic.


We conclude that outpatient IV therapy of refractory headaches/Migraines is highly successful with an extremely low need for re-treatment, contributing to productivity in the workplace, at home and in personal life. This method of treating refractory Migraines is much more satisfactory than using currently available (and limited) pharmacologic agents given commonly in the ED.


Krusz, John Claude, PhD, MD; Belanger, Jeanne, RN; Cagle, Jane, LVN. "IV Treatment of Refractory Migraines in the Headache Clinic: High Success Rate." Poster Abstract. 49th Annual Scientific Meeting of the American Headache Society. Chicago. June, 2007; in Headache, 47:752, May 2007.

Teri Robert
Meet Our Writer
Teri Robert

Teri Robert is a leading patient educator and advocate and the author of Living Well with Migraine Disease and Headaches. A co-founder of the Alliance for Headache Disorders Advocacy and the American Headache and Migraine Association, she received the National Headache Foundation's Patient Partners Award and a Distinguished Service Award from the American Headache Society.