ED Pathway for the Evaluation/Treatment of the Child with Migraine Headache
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PO/IV Therapy
  • Metoclopramide
  • Ibuprofen/Ketorolac
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Reassess
Significant HA Persists
  • Call Neurology for
    Valproate vs. Methlyprednisolone/ Zantac
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Reassess
Significant HA Persists
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IV Therapy
  • Metoclopramide
  • Ketorolac
  • NS bolus
Immediate Neurology Consult
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Reassess
Significant HA Persists
  • Follow Neurology recommendations
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Reassess
Significant HA Persists

Reassess patient 30 min after each intervention

Assessment includes:

  • Vital signs
    Pain scale
    Brief Neuro exam
  • Resolution of associated symptoms

 

If significant headache persists, proceed to the next intervention

Migraine Headache Medications
Metoclopramide
0.2 mg/kg IV/PO, max 10 mg if < 12y/o
max 20 mg if ≥ 12y/o
Ketorolac 0.5 mg/kg IV, max 30 mg OR

Ibuprofen

10 mgl/kg PO, max 800 mg

(administer if no NSAID given within previous 6 h)
Valproate 15 mg/kg IV, max 1 g
Methylprednisolone
Zantac
2 mg/kg IV, max 200 mg
1 mg/kg IV, max 50 mg
Posted: February 2010
Revised: October 2011
Authors: J. Lavelle, MD, C. Jacobstein, MD, D. Glatts, RN, D. Younkin, MD, N. Abend, MD, C. Szpreka, MD