Calgary neurologist Dr. Serena Orr spent her career researching migraine attacks and trying to bring patients relief from the painful symptoms.
But it wasn’t until she moved to Calgary that she gained a whole new perspective with a migraine attack of her own.
“I had mild headaches in all the other places I lived but didn’t think anything of it. It was during COVID. I couldn’t get off the couch. I had severe nausea and brain fog. When the fog started to fade, I realized I didn’t have COVID. I had experienced a severe migraine attack,” Orr said.
“I didn’t understand how bad it was until I experienced it myself. It is super ironic.”
Orr, an associate professor at the University of Calgary’s Cumming School of Medicine, worked in collaboration 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 2016 guidelines of the American Headache Society for the management of migraine attacks in emergency departments.
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The update reviewed 26 studies from the past nine years that met the criteria involving migraines and visits to emergency departments to bring the treatment recommendations up to date.
“This update marks a major change in emergency department migraine care and implementing these treatments can improve patient outcomes and reduce reliance on opioids,” said study co-lead Dr. Jennifer Robblee, a neurologist and migraine and headache disorders specialist at Barrow Neurological Institute.
The research recommends occipital nerve blocks should be offered in emergency rooms to treat acute migraine attacks.
The use of intravenous Prochlorperazine which blocks dopamine receptors in the brain is recommended but is not readily available. That leaves the greater occipital nerve block where a local anesthetic and a corticosteroid are injected near the greater occipital nerve.
“The occipital nerves at the base of the skull bring in pain signals to the same area of the brain where pain signals from all over the head are coming in. By anesthetizing these nerves, patients get relief,” said Orr.
“A needle at the back of the head and pushing in a local anesthetic for the nerves to numb the back of the head also changes the pain signaling from all over the head and the brain.”
Orr was lead author on the 2016 guidelines which were adopted in Canada and has reached out to the Canadian Headache Association and other neurologists and emergency room doctors to encourage their implementation.
“They are American Headache Society’s guidelines but now that they’ve been published this week I’m in touch with Canadian organizations,” she said.
“They’re looking at it and are likely to endorse the things on it.”
The study also recommends against using opioids to treat headaches because other treatments are better and because of the possible addiction issues.
Orr said migraines are one of the most common neurological diseases in the world and are largely believed to be genetic, with other factors including childhood trauma or even weather conditions and altitude being aggravating factors.
The needles need to be applied by physicians or nurse practitioners but Orr doesn’t think most patients would mind.
“The extent of the pain and discomfort made me realize on a very personal level that I would do anything to get rid of it including put needles in my head,” she said.
“Does that mean it’s a cure for everybody? No. We don’t have anything for migraines that everybody will respond well to. We know it’s going to help a lot of people due to good quality research.”
This report by The Canadian Press was first published December 5, 2025.
© 2025 The Canadian Press