Migraine Headache Clinical Pathway — Inpatient
Migraine Headache Clinical Pathway — Inpatient
Discharge Criteria
- Headache resolved, or decreased to baseline level in those with constant baseline pain and has remained there for 12 hours even with increased activity.
- Patient/parent feels that the headache is sufficiently better so that the child can function. However, if headache has rebounded within 24 hrs in the past after IV treatments, aim for #1 and consider giving a dose of Methylprednisolone prior to discharge if not given within the preceding 72 hours.
- Headache has not improved, but patient, parent, and inpatient team feel that benefits of continued inpatient treatment are outweighed by adverse effects, or there are no other available options. In this case, it is very important to stress that multidisciplinary outpatient care, with combined use of preventive medications and cognitive behavioral therapy, is likely to help over time. The patient should be set up for an appointment with a known neurologist within a few weeks and a referral should be made to psychology (either the headache program psychologist specifically for pain coping strategies or a local referral if there is a need for long-term treatment of psychiatric comorbidities). If the inpatient team feels that the patient would benefit from long-term follow-up in the headache clinic, please discuss this with a headache program attending.