Headaches: treatment in ED

Many emergency physicians use an intravenous fluid bolus as part of a 'cocktail' of therapies

for patients with headache, but it is unclear if this is beneficial.

The objective of this study (Zitek T, Sigal T, Sun G, et al. Emerg Med J 2020;37:469-473.) was to determine if an intravenous fluid bolus helps reduce pain or improve other outcomes in patients who present to the ED with a benign headache.

All patients received prochlorperazine and diphenhydramine,

and they were randomised to also receive either 20mL/ kg up to 1000mL of normal saline (the fluid bolus group) or 5mL of normal saline (the control group).

The primary outcome was the difference between groups in mean pain reduction 60min after the initiation of treatment.

The study lacked statistical power to detect small but clinically significant differences, ED patients who received an intravenous fluid bolus for their headache had similar improvements in pain and other outcomes compared with those who did not.