Dr. Serena Orr, a Calgary neurologist, has spent her career researching migraine attacks and helping patients relieve their painful symptoms.
But it wasn't until she moved to Calgary that her own migraine attacks gave her a whole new perspective.
“Elsewhere I lived, I had a mild headache, but I didn't think anything of it. It was during coronavirus. I couldn't get off the couch. I had severe nausea and brain fog. When the fog started to lift, I realized I didn't have coronavirus. I was experiencing severe migraine attacks,” Orr said.
“I didn't realize how bad it was until I experienced it myself. It's so ironic.”
Orr, an associate professor at the University of Calgary's Cumming School of Medicine, collaborated with researchers at the University of Calgary's Hotchkiss Brain Institute and the Barrow Neurological Institute at Dignity Health St. Joseph's Hospital and Medical Center in Phoenix, Arizona.
The findings are published in Headache: The Journal of Head and Face Pain and update the American Headache Society's 2016 guidelines for managing migraine attacks in the emergency department.
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In this update, we reviewed 26 studies from the past nine years that met our criteria for migraine and emergency department visits to bring treatment recommendations up to date.
“This latest information represents a major shift in emergency department migraine care, and implementing these treatments can improve patient outcomes and reduce dependence on opioids,” said study co-lead Dr. Jennifer Roble, a neurologist at Barrow Neurological Institute and an expert in migraine and headache disorders.
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This study recommends that occipital nerve blocks should be offered in the emergency room to treat acute migraine attacks.
Intravenous use of prochlorperazine, which blocks dopamine receptors in the brain, is recommended but is not readily available. This leaves a greater occipital nerve block and local anesthetic and corticosteroids are injected near the greater occipital nerve.
“The occipital nerves, located at the base of the skull, carry pain signals to the same areas of the brain that receive pain signals from all over the head. By anesthetizing these nerves, patients can experience relief,” Dr. Orr says.
“When we numb the back of the head by putting a needle in the back of the head and injecting local anesthetic into the nerves, the pain signals that travel throughout the head and brain also change.”
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Dr. Orr was the lead author of the 2016 guidelines adopted in Canada and has worked with the Canadian Headache Society and other neurologists and emergency room physicians to encourage implementation of the guidelines.
“These are guidelines from the American Headache Society, but they came out this week, so we're in contact with the Canadian organization,” she said.
“They have considered it and are likely to support what is written there.”
The study also recommends against using opioids to treat headaches, as other treatments are better and addiction problems can occur.
Dr Orr said migraines are one of the most common neurological disorders in the world and are thought to be primarily genetic, with other factors including childhood trauma and even weather conditions and altitude being exacerbating factors.
It would require a doctor or nurse to insert the needle, but Orr believes most patients won't mind.
“Seeing the level of pain and discomfort made me realize on a very personal level that I would do anything to get rid of it, including putting a needle in my head,” she said.
“Does that mean there is a treatment that works for everyone? No, there is no treatment for migraine that everyone responds well to. Thanks to high-quality research, we know that many people can benefit.”
This report by The Canadian Press was first published Dec. 5, 2025.
© 2025 The Canadian Press