Inpatient Clinical Pathway for the Evaluation/Treatment
of Children with a Migraine Headache
- 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
- Integrative Health
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: November 2020
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.
- Approach to Pediatric Intractable Migraine
- Headaches in Children and Adolescents
- Treatment of pediatric migraine in the emergency room.