- Consider Differential Diagnosis
- Review ED, Pre-hospital Care, Prior Medications, Failed Treatments
- Current Pain Score
- Testing Related to Treatment for All Patients
- Sufficient Clinical Improvement
- Decreases in Pain Score by 1 Point
- Patient Reports Subjective Improvement
- Reassess Every 8-12 Hours to Ensure Continued Improvement
- Consider Adjunctive Pain Management Interventions
- Patient Education
- Child Life
- Social Work
Pathway assumes patient has received Ketorolac, Metoclopramide, and Valproic Acid at this point.
If additional medications administered in ED, advance along pathway as clinically indicated.
Modify protocol as needed dependent on success/failure/side effects of past medications.
- DHE Protocol/Progression/
Side Effect Management
- If insufficient improvement after 3 Doses
- Discuss Nerve Block
- Consider Valproic Acid, Magnesium
- If insufficient improvement after 5 doses
- Consider Levetiracetam
Revised: May 2017, March 2018, February 2019, March 2019
Authors: C. Szperka, MD; P. Betts, PharmD; K. Dorland, RN; D. Karvounides, PhD; C. Malavolta, CRNP;
N. Lin, MD; J. Lavelle, MD; C. Salas-Humara, MD
- A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department
- Effectiveness of standardized combination therapy for migraine treatment in the pediatric emergency department.
- Treatment of pediatric migraine headaches: a randomized, double-blind trial of prochlorperazine versus ketorolac.
- Pediatric headaches in the emergency department.
- Treatment of pediatric migraine in the emergency room.