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Migraine and Migraine-like Headache – Acute Management

Pathway Background and Objectives

Migraine headaches are a common reason patient’s present to the children’s emergency department. Such headaches have a considerable adverse impact on quality of life, and afflicted children may be seek emergent relief. Currently, there is a range of practices used by emergency medicine providers. Pharmacotherapies typically utilized in such patients include intravenous normal saline, metoclopramide, prochlorperazine, promethazine, ondansetron, diphenhydramine, non-steroid analgesic drugs, steroids and triptans. Standardizing pharmacotherapy will provide for safer patient care, and will also facilitate outpatient referrals for appropriate patients. By incorporating this pathway, providers may also be better able to identify worrisome secondary headaches, due to an underlying pathology.

  • To facilitate provider comfort in managing migraine-like headache through standardization of therapy including second line agents
  • To improve throughput in the emergency department with patients who present with migraine-like headache
  • To provide consistent care, both in the department and upon disposition, to children with migraine-like headache


Download Acute Management of Migraine and Migraine-Like Headache Pathway Algorithm

Quality Metrics

  1. Admission Rate
  2. Rate of return for headache within 48 hours
  3. Rate of return for headache within one week
  4. Time to first dose of medication
  5. Rate of neuroimaging during ED visit
  6. Time to disposition
  7. Pain score at disposition
  8. Percentage change in pain scale from time of initial evaluation to time of disposition
  9. Percent use of pathway

Educational Module

Download Acute Management of Migraine and Migraine-Like Headache Educational Module

Key References

Pathway Contacts


The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.

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