Migraine Headache — Admission vs Discharge — Clinical Pathway: Emergency

Migraine Headache Clinical Pathway — Emergency Department

Admission vs Discharge

Significant Headache Persists

  • Consider admission for pain control if the patient may benefit from IV medications, or if the patient’s family has a preference for admission due to failed outpatient management.
  • Please continue to treat pain with next-line medication while awaiting bed assignment.
  • Patients with stable chronic migraine headache who previously repeatedly failed all IV therapies, discuss:
    • Interim management with the Neurology Consult Fellow.
    • The option of discharge with a plan for expedited Neurology follow-up in
      1-2 weeks, even if no improvement in ED.
  • Consider baseline ECG if patient being admitted for DHE treatment.
Admitting Service Indications
Neurology
  • New onset headache is primary reason for admission.
  •  
  • Migraine is the primary reason for admission, and the patient has a history of needing procedural treatments, needs imaging or testing, or there is a concern that the patient may not improve with medications on the Inpatient Migraine Pathway.
General Pediatrics
  • Migraine is primary reason for admission, and patient has a history of migraine and is expected to improve with medications on the Inpatient Migraine Pathway.
Adolescent Service
  • Headache is part of a greater pain problem or patient has complex medical or psychiatric comorbidities.
  • If patient fits this description but is followed by Neurology for migraine, discuss with Neurology and/or Adolescent team regarding admitting service.

ED Discharge Directions