Migraine Headache — Migraine Headache in Children ≥ 5 Years — Clinical Pathway: Emergency

Migraine Headache Clinical Pathway — Emergency Department

Complaint of Migraine Headache in Children ≥ 5 Years

This pathway should be used for children ≥ to 5 years with suspected migraine. Status migrainosus is when there are typical migraine features of a headache lasting longer than 72 hours and no secondary cause. Classic diagnosis of migraine is when there is headache lasting 1-72 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:

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