Our Migraine IV protocol consists of high dose magnesium (2000-3000 mg!) as well as specific vitamins and other pharmaceuticals to not only provide immediate relief for migraines but also the option of additional medications such as dexamethasone to help mitigate future migraine attacks.
Most common ingredients used (per provider discretion): magnesium, potassium, b complex, b6,vitamin d, toradol, reglan, benadryl,zofran, phenergan, dexamethasone. We will work with you to decide the best customized drip for you!
We also recommend nutraceuticals to further mitigate future attacks and help get you back on the road to living your best life!
WORKUP AND MONITORING RECOMMENDATIONS
Required - Vital signs before , during and after***
A basic workup on file is a general recommendation for ongoing high dose injections or infusions (baseline CBC/CMP/GP6/UA) - available through Nervana Medical or we will accept labs within the last year from service date
Myasthenia Gravis, Myxedema, Cerebral Hemorrhage
Current UTI - Might increase urinary pH, which might promote further bacteria growth. It is better to just wait a day or two after a patient starts antibiotics.
HyPOkalemia - Replace orally prior to infusion. Magnesium induces influx of potassium into cells, leading to lower potassium and muscle cramps. (vomiting/diarrhea, diuretics, glucocorticoids, malnourishment)
Decrease infusion rate or lower magnesium dose for BP <100/70
Diphenhydramine can cause drowsiness, patient should have a ride home
Both Promethazine and Metoclopramide carry the risk of extrapyramidal side effects/ tardive dyskinesia (albeit higher risk relative to dose and frequency dependent). Higher risk with Promethazine than Metoclopramine 19% vs 5%); Risk factors for developing tardive dyskinesia are: Older age, higher dose, and female sex are risk factors for development of these side effects. Tardive dyskinesia is rare in young patients. Early detection and discontinuation of the metoclopramide are important for the prevention of permanent tardive dyskinesia.. Discontinue everything if tardive dyskinesia becomes apparent.
Recommended as needed based on symptoms and benefits