Effective Emergency Department Treatment of Acute Migraines
Grand Canyon University: NRS-433V
January 12, 2014

In 2011 a research to practice article was published in the Advanced Emergency Nursing Journal by Patricia Kunz Howard and Susan E. Shapiro on effective acute migraine treatment in the emergency department. Kunz Howard and Shapiro reviewed and critiqued a research study by Kostic, Gutierrez, Rieg, Moore, & Gendron (2010), titled “A prospective, randomized trial of intravenous prochlorperazine versus subcutaneous sumatriptan in acute migraine therapy in the emergency department,” that was originally published in the Annals of Emergency Medicine. The clinical/ research problem that led to this particular study was to find out whether there was a clinically significant difference in two different treatments for acute migraines in the emergency department. Currently pain management for headaches is considered controversial. The Agency for Healthcare Research and Quality is currently evaluating migraine management. This is part of an effective health care program that is focused on providing evidence for clinical providers caring for a specific patient population; an example would be migraine headaches in the ED. (Kunz Howard & Shapiro, 2011) For this study there were 187 patients that presented to the ED with a headache in the study period, 66 of which completed the study. The groups of patients in the prochlorperazine group (35 patients) reported a greater overall improvement in pain than the sumatriptan group (31 patients). These patients reported that their pain was relieved more quickly and there appeared to be less variability in their responses. There was also reported fewer recurrences of headaches with the prochlorperazine group. (Kunz Howard & Shapiro, 2011). The purpose of this study was to determine whether intravenous prochlorperazine and diphenhydramine is a superior treatment for migraine headaches then subcutaneous sumatriptan in the emergency department. One of the research questions that they were attempting to answer was which treatment would provide better relief of pain? Which would provide better relief of nausea? And which treatment was less sedative. The purpose and research questions were directly related to the problem. The qualitative methods they used were appropriate. They used a visual analog scale (VAS) to quantify each patient’s subjective experiences of pain, sedation, and nausea. To use a VAS, each patient places a hash mark on a spot along a line, from 0-100 mm, that indicates his or her current level of pain, nausea, or sedation. This allows the researchers to measure the difference between ratings at each time period in terms of millimeters (mm). (Kunz Howard & Shapiro, 2011) There were no other studies that were cited in this article, although they did report that based on previous studies there was a difference in scores needed, defined by the investigators, of 13-mm for the study to be deemed clinically important. They did cite the Agency for Healthcare Research and Quality (2011) as well as Crichton (2001) for information on the VAS scale and the Joanna Briggs Institute (2011) for information on Levels of evidence: FAME. Although there were no other studies cited, the other literature used for this paper was current. There was no evaluation of other studies. Since there was not really a literature review included I don’t believe there was information for a logical argument, although the results of the study did show a clinically important difference in results of using prochlorperazine versus sumatriptan. The article that I chose was a research to practice column, which is used to assist APNs with the translation of research into their practice. The writers choose a research study and set the stage by introducing the topic using a case-based scenario in order to show the topic’s importance. The authors then review and critique the research paper and discuss the implication for translation into practice.

References
Kunz Howard, P. & Shapiro, S. (2011). What is effective acute migraine treatment in the emergency department? Advanced Emergency Nursing Journal. 33:3. 200-204. doi: 10.1097/TME.0b013e31822384fb.