Many patients who present to the emergency department(ED) with severe headache request a narcotic to relieve thepain.
Many patients who present to the emergency department(ED) with severe headache request a narcotic to relieve thepain. Past histories are sometimes difficult to document,especially on weekends or if the patient is "visiting from outof-town." If the patient claims that the current headache issimilar to past headaches and is not of new onset or of a differentintensity, duration, or nature, what effective alternativesto narcotics and antiemetics can be given?-- James E. Hill, PA-C, MEd
 Charlotte, NCMost patients who come to the ED with asevere headache have migraine. Severalalternative therapies can be used insteadof narcotics to treat acute headache:
Solid evidence shows that narcotics usually provideonly transient relief from pain. Most patients who find narcoticshelpful probably benefit from the sleep they induce.
-- Robert S. Kunkel, MD
 Headache Center
 The Cleveland Clinic Foundation
 Cleveland