Main finding: Since the last guideline that was issued in 2016, we have found new studies about treating severe migraine attacks in the emergency room. This summary outlines our plan to review these studies and update the previous guidelines. Motivation: The American Headache Society Guideline Committee updates its guidelines as needed. Although the 2016 guideline was well done, new information is available that might change our recommendations. Methods: We will conduct an updated review using the same methods as the 2016 guideline. We will search Medline, Embase, Cochrane, clinicaltrials.gov, and the WHO International Clinical Trial Registry Platform. We will include studies on adults with migraine treated with injectable medications. Two authors will review each study's title and abstract, followed by the full text. If there is a disagreement, a third author will decide. We will assess the studies for bias using a standard tool. For some studies, we will perform a meta-analysis. We will categorize medications as "highly likely," "likely," or "possibly" effective or ineffective. The results will include a discussion of medications' risks. Results: Our goal is to provide guidance on which injectable treatments, including nerve blocks and sphenopalatine ganglion blocks, work best for adults with migraine in the emergency room. Implications: This summary outlines our plan to use an updated review and analysis to create new guidelines for the treatment of adults with migraine in the emergency room. Jennifer Robblee: Conceptualization; writing – original draft; writing – review and editing. Xurong (Rachel) Zhao: Conceptualization; writing – original draft; writing – review and editing. Mia T. Minen: Conceptualization; writing – original draft; writing – review and editing. Benjamin W. Friedman: Conceptualization; writing – original draft; writing – review and editing. Miguel A. Cortel-LeBlanc: Conceptualization; writing – original draft; writing – review and editing. Achelle Cortel-LeBlanc: Conceptualization; writing – original draft; writing – review and editing. Serena L. Orr: Conceptualization; writing – original draft; writing – review and editing. Jennifer Robblee discloses grant support from Barrow Neurological foundation, investigator support from Eli Lilly and Abbvie, as well as paid Editorial relationship with MedLink Neurology and Neurodiem. She has received personal compensation for serving on advisory boards for Allergan/Abbvie. She also discloses that a family member has partial ownership of Scottsdale Providence Recovery Center biomedical company. Xurong (Rachel) Zhao has nothing to disclose. Mia Minen has salary support from a National Institutes of Health award. Benjamín Friedman has nothing to disclose. Miguel A. Cortel-LeBlanc has received honoraria from the Canadian Association of Emergency Physicians for educational events, and from AbbVie for speaking engagements. He receives an honorarium from the Ontario Medical Association for serving as a member of the Physician Payment Committee. He has also received consulting fees for the provision of medico-legal expert opinions. Achelle Cortel-LeBlanc is a minority shareholder and on the leadership team at 360 Concussion Care Inc.; receives consulting fees for medico-legal expert opinions and independent medical evaluations; has received honoraria from Abbvie/Allergan for speaking events; receives honoraria from the Ontario Medical Association for work on the Neurology Section Executive; receives a stipend from the University of Ottawa for working as a rotation director; is a co-investigator on research funded by the University of Ottawa Brain and Mind Research Institute. Serena L. Orr receives royalties from Cambridge University Press. She serves on the editorial boards of Headache, Neurology, and the American Migraine Foundation. She also has research funding from the Canadian Institutes of Health Research and the Alberta Children's Hospital Research Institute.
