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 Algorithm Download Acute Management of Migraine and Migraine-Like Headache Pathway Algorithm Quality Metrics Admission Rate Rate of return for headache within 48 hours Rate of return for headache within one week Time to first dose of medication Rate of neuroimaging during ED visit Time to disposition Pain score at disposition Percentage change in pain scale from time of initial evaluation to time of disposition Percent use of pathway Educational Module Download Acute Management of Migraine and Migraine-Like Headache Educational Module Key References Bachur RG, Monuteaux MC, Neuman MI. A comparison of acute treatment regimens for migraine in the emergency department. Pediatrics. 2015 Feb;135(2):232-8. Kaar CR, Gerard JM, Nakanishi AK. The Use of a Pediatric Migraine Practice Guideline in an Emergency Department Setting. Pediatr Emerg Care. 2016 Jul;32(7):435-9. Leung S, Bulloch B, Young C, et al. Effectiveness of standardized combination therapy for migraine treatment in the pediatric emergency department. 2013 Mar;53(3):491-97. Oskoui M, Pringsheim T, Holler-Managan Y, et al. Practice guideline update summary: Acute treatment of migraine in children and adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society.Neurology. 2019 Sep;93(11):487-499. Pathway Contacts Rahul Shah, MD Henry Chicaiza, MD Eric Hoppa, MD Disclaimer 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. View all Clinical Pathways >
