Migraine Headache — Medication Progression, Dosing — Clinical Pathway: Inpatient

Migraine Headache Clinical Pathway — Inpatient

Medication Progression, Dosing

Assessing Response to Medications

Medications

Medication Dose Maximum Route/Interval Comment/SE
Ketorolac 0.5 mg/kg 30 mg IV q 8 hours
  • Heartburn, usually does not require treatment
  • Renal, GI toxicity limit to 5 consecutive days (15 doses)
Metoclopramide 0.2 mg/kg 10 mg PO/IV q 8 hours
  • Sedation
  • Restlessness, agitation, dystonic reaction — Treat with Diphenhydramine, 1mg/kg IV/PO, max 25 mg, premed 30 minutes before future doses preferably PO
Valproic Acid 15 mg/kg 1000 mg IV q 12 hours
  • Sedation, nausea, dizziness
  • Significant SE rare with single dose
  • Infuse over 20 minutes to avoid local irritation
Methylprednisolone 2 mg/kg 200 mg IV once daily
  • Start in AM if not given in the ED to minimize insomnia
  • If effective, start famotidine to avoid GI SE, continue for a maximum of 3 days
  • Increased appetite, agitation
  • Hypertension, hyperglycemia
  • Infuse over 1 hour to avoid local irritation
Magnesium Sulfate 50 mg/kg 1000 mg IV q 12 hours
  • Infuse over 1hr, increase to 2hr if needed to avoid side effects
  • Dizziness, sedation, burning, hypotension
  • STOP infusion if symptomatic hypotension, arrhythmia, CNS depression, apnea
Levetiracetam 20 mg/kg 1000 mg IV q 12 hours
  • Sedation, irritability, usually does not require treatment
DHE Recommendations