Migraine and Migraine-like Headache

Pathway Background and Objectives

Migraine headaches are a common reason patients present to the emergency department. Migraines 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 implementing this pathway, providers may also be better able to identify worrisome secondary headaches that are due to an underlying pathology. The specific objectives of this pathway are:

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

Algorithm  Educational Module

 

 

  • Percentage of eligible patients managed per pathway
  • Percentage of patients with migraine who are admitted to the hospital
  • Rate of return to ED for headache within 48 hours
  • Rate of return to ED for headache within 7 days
  • Time from arrival to ED to administration of first dose of medication
  • Average time from ED arrival to disposition
  • Average pain score at disposition
  • Percent change in pain score from time of initial evaluation to time of disposition
  • Usage of IN sumatriptan
  • Usage of sphenopalatine block

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.