Emergency Department Clinical Pathway for the Evaluation/Treatment of Children with a Migraine Headache
Related Pathways
Headache Red Flags
- Headache with altered mental status and/or focal neurologic findings
- Care as indicated
- Consider Stroke Protocol
- Imaging, Neurology Consult
- Differential Diagnosis for Headache
- Guidance for MR Imaging Overnight Hours
History of Rebound Headache
- Consider 1 dose Methylprednisolone
- Home prescription for Medrol Dosepak
- Neurology follow-up
Initiate Migraine Bundle Treatment
- Metoclopramide (IV/PO)
- Ketorolac/Ibuprofen
- IV fluid/ PO Hydration
- Adjunctive Therapies
- Reassess 45 minutes
- Give Valproic Acid
- Continue Adjunctive Therapies
- Reassess 45 minutes
- Consider
- Admission vs Discharge
- Next Line Treatment
- Review
- Education/home prescription regimen
- Consider Valproic Acid tx for 2 weeks
- Healthy habits
- Education/home prescription regimen
- Follow up
- Neurology
- Review
- Education/home prescription regimen
- Healthy habits
- Follow up
- Neurology
- Primary Care
Reassess 45 minutes after each intervention
Assessment includes:
Assessment includes:
- Vital signs, brief neuro exam
- Pain scale
- Resolution of associated symptoms
| Medication | Dose | Route | Max |
|---|---|---|---|
| Metoclopramide | 0.2 mg/kg | IV/PO | 10 mg |
| Ketorolac* | 0.5 mg/kg | IV | 30 mg |
| Ibuprofen | 10 mg/kg | PO | 800 mg |
| Valproic Acid | 15 mg/kg | IV | 1 gram |
| Methylprednisolone | 2 mg/kg | IV | 200 mg |
| *Ketorolac may be given within 1 hour of last PO NSAID dose as escalation of therapy if no hx of renal insufficiency *It can be given without HCG results unless the patient is in the 3rd trimester of pregnancy, Class D |
|||
Posted: February 2010
Last Revised: November 2024
Authors: N. Hughes, MD; C. Szperka, MD; J. Lavelle, MD; C. Jacobstein, MD; D. Younkin, MD, M. Chadehumbe, MD;
C. Patterson Gentile MD, PhD; J. Zook, PharmD; M. Wengler, CRNP; R. Prendergast, CRNP; N. Strobel, CRNP; N. Abend, MD
Last Revised: November 2024
Authors: N. Hughes, MD; C. Szperka, MD; J. Lavelle, MD; C. Jacobstein, MD; D. Younkin, MD, M. Chadehumbe, MD;
C. Patterson Gentile MD, PhD; J. Zook, PharmD; M. Wengler, CRNP; R. Prendergast, CRNP; N. Strobel, CRNP; N. Abend, MD
Evidence
- A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department
- Effectiveness of standardized combination therapy for migraine treatment in the pediatric emergency department.
- Treatment of pediatric migraine headaches: a randomized, double-blind trial of prochlorperazine versus ketorolac.
- Approach to Pediatric Intractable Migraine
- Headaches in Children and Adolescents
CHOP Programs
Educational Media
- ED Migraine Pathway RN Learning Assessment
- RN Learning Module
- Pediatric Chronic Pain
- Primary Care Perspectives: Podcast for Pediatricians
Episode 141: Managing Pediatric Migraine Headaches in Primary Care