Optimizing Migraine Care: When to Refer to Infusion Therapy.

For patients with refractory, severe, or prolonged migraines, intravenous infusion therapy can be a highly effective next step when standard treatments fail. Outpatient headache infusion protocols have been shown to improve compliance, shorten attacks, and reduce emergency department utilization compared to ER-based care (PracticalNeurology.com). At our infusion center, we provide structured, evidence-informed migraine infusion services designed to stabilize symptoms quickly and safely—without the noise, delays, and unpredictability of the hospital setting.

When to Refer a Patient for IV Migraine Therapy

• 1. Status Migrainosus
• 1Migraine lasting longer than 72 hours despite triptans, NSAIDs, gepants, or steroids.
• 2. Refractory Migraine Attacks
• Pain unresponsive to oral or subcutaneous medications due to:
• Severe nausea or vomiting
• Gastroparesis
• Medication intolerance.
• Inadequate relief with home rescue therapy
• 3. Frequent ED Utilization.
• Patients who repeatedly seek emergency care for migraine flares benefit from outpatient infusion—reducing exposure to opioids, unnecessary imaging, and prolonged wait times.
• 4. Dehydration or Significant Autonomic Symptoms
• Patients with dehydration, dizziness, or persistent nausea that complicates oral medication absorption.
• 5. Provider-Directed Early Intervention.
• Neurologists and primary care providers may pre-empt escalation by referring at the onset of a severe attack to prevent progression into status migrainosus.

What Our Infusion Protocol Includes
Our center follows flexible, provider-driven protocols that may include:

• IV fluids
• Anti-emetics.
• NSAIDs
• Magnesium
• Steroids
• Ketorolac (as ordered)
• Diphenhydramine or other adjunctive therapies as clinically appropriate.
• All infusions are monitored by trained nurses, with vital signs and symptom response documented throughout the visit.

Why Refer to Outpatient Infusion Instead of the ED?

Faster symptom control with direct IV access.

• Lower risk of unnecessary imaging and opioid exposure
• Reduced hospital and ED utilization
• Improved patient satisfaction and compliance
• Quiet, controlled environment optimal for sensory sensitivity
• According to Practical Neurology, outpatient infusion therapy provides a superior pathway for recurring severe migraines, offering a structured and efficient alternative to emergency care.
• Collaborative, Streamlined Referral Process
• We coordinate directly with referring neurologists and primary care clinicians to ensure:
• Rapid scheduling for urgent cases
• Clear communication of infusion outcomes
• Documentation of response and follow-up needs
• Ongoing support for patients with chronic migraine patterns

Kariah Healthcare LLC delivers the operational reliability and clinical safety that high-acuity heart failure patients require.

• Call our infusion center for referral criteria and authorization processes: (240) 852-9384 Kariah Healthcare LLC – Your partner in comprehensive outpatient migraine management.