Migraine Headache — MD/CRNP/RN Assessment and IV vs PO Treatment — Clinical Pathway: Emergency

Migraine Headache Clinical Pathway – Emergency Department

MD/CRNP/RN Assessment and IV vs PO Treatment

General
  • Complete set VS
  • CR monitor with appropriate alarms
Brief Neurologic Assessment
  • Mental status
  • Pupils
  • Symmetry of cranial nerves
  • Symmetry of motor exam
Pain
  • Assess and document with appropriate scales
IV vs PO
  • Assess need for IV
Labs
  • Urine or blood HCG
Notify attending immediately if abnormal mental status, focal neurologic findings

If any focal neurologic findings or altered mental status, consider:

Considerations for PO vs IV Treatment

PO
  • Mild/moderate headache
  • No current vomiting
  • Suboptimal dosing/frequency of NSAIDS at home
IV
  • Moderate/severe headache
  • Currently vomiting
  • Lack of response to appropriate NSAID use defined as Ibuprofen 10 mg/kg, maximum 800 mg within preceding 6 hours
IV Fluids
  • Give 20 mL/kg (Max 1000 mL) of normal saline bolus to patients requiring IV analgesia
  • Reassess hydration status