Migraine Headache Clinical Pathway — Emergency Department

MD/CRNP/RN Assessment and IV vs PO Treatment

General	Complete set VS CR monitor with appropriate alarms
Brief Neurologic Assessment	Mental status Pupils Symmetry of cranial nerves Symmetry of motor exam
Pain	Assess and document with appropriate scales
IV vs PO	Assess need for IV
Labs	Urine or blood HCG
Notify attending immediately if abnormal mental status, focal neurologic findings

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

Considerations for PO vs IV Treatment

PO	Mild/moderate headache No current vomiting Suboptimal dosing/frequency of NSAIDS at home
IV	Moderate/severe headache Currently vomiting Lack of response to appropriate NSAID use defined as Ibuprofen 10 mg/kg, maximum 800 mg within preceding 6 hours
IV Fluids	Give 20 mL/kg (Max 1000 mL) of normal saline bolus to patients requiring IV analgesia Reassess hydration status

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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.