Despite guidelines that recommend against opioid use as first-line treatment for migraine headaches, meperidine (Demerol) is still administered in 36% of all migraine headache ED visits in the U.S.
Meperidine's lack of efficacy, adverse effects such of seizure, and toxic metabolic accumulation all contribute to its use for migraine headaches being discouraged.
A recent meta-analysis out of New York again supports the avoidance of using meperidine for migraine headaches, and instead, encourages clinicians to use anti-emetic and dihydroergotamine regimens.
References
Friedman, et al. "The Relative Efficacy of Meperidine for the Treatment of Acute Migraine: A Meta-analysis of Randomized Controlled Trials." Annals of Emergency Medicine. December 2008; Vol. 52, No. 6; 705-13.
