The American Headache Society recently published updated guidelines for the acute treatment of migraine in adult patients presenting to the emergency department. Based on the strength of available evidence, intravenous prochlorperazine was classified as highly likely to be effective, supported by multiple Class I studies. Intravenous metoclopramide and intravenous ketorolac (personal opinion: we have to discuss use of this in the ED) were considered likely effective, based on either one Class I study or multiple Class II studies. In contrast, intravenous hydromorphone, intravenous propofol, and intravenous acetaminophen (paracetamol) were categorized as likely ineffective, supported by evidence from Class I or multiple Class II studies.