Hospitalized patients with refractory headache may experience prolonged admissions and substantial healthcare-related costs. Existing guidelines largely emphasize outpatient management, leaving clinicians with limited inpatient-specific guidance to inform care. This practice advisory 1 synthesizes the available literature on intravenous therapies commonly used for inpatient headache treatment and provides consensus-based clinical recommendations. Using a structured review process and two rounds of Delphi voting, the expert panel developed 12 consensus statements and 17 clinical recommendations, each graded for strength and certainty of evidence. Although most evidence was low to moderate in certainty, high agreement among authors was achieved across all recommendations. The accompanying infographic highlights key safety considerations and best-practice recommendations for commonly used intravenous agents for inpatient headache management, including corticosteroids, dihydroergotamine, dopamine antagonists, ketamine, ketorolac, levetiracetam, lidocaine, magnesium, and valproic acid. Together, these recommendations provide practical guidance to support safe, standardized inpatient management of refractory headache while underscoring the need for future prospective research in this population.
D’Souza et al. (Fri,) studied this question.