Migraine Headache Clinical Pathway — Inpatient

Child With Migraine Headache: Episodic, Chronic, or New Onset

This pathway should be used for children ≥ 5 years of age with a headache lasting 1 to 72 hours, which is not thought to be due to another disorder AND has at least two of the following:

Non-occipital in location (may be unilateral, bilateral, frontotemporal)
Pulsating quality
Moderate/severe pain intensity
Aggravated by or causing avoidance of routine physical activity

And at least one of the following:

Nausea, vomiting or both
Photophobia and phonophobia

If there is no concern for another etiology, this pathway may be used even if full criteria are not met.

If any focal neurologic findings or altered mental status, consider:

Stroke Pathway

Modify the treatment as needed if patient has had previous success, failure or side effects with specific medications. Always maintain a high suspicion for an underlying cause. Use the .ipneuro admit note for guidance on HA classification.

Headache Classification

Episodic Migraine	Acute HA in child with episodic migraine, HA < 15 days monthly
Chronic Migraine	Acute HA in a child with history of frequent or constant HA for > 3 months
New Onset	New Onset HA for < 3 months without concern for another serious cause

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.