The Use of a Pediatric Migraine Practice Guideline in an Emergency Department Setting

Abstract

Our MCPG was clinically safe and effective in treating children with acute migraine headaches. Our data add to the dearth of existing published literature on migraine treatment protocols in the ED setting. We recommend additional prospective and comparative studies to further evaluate the effectiveness of our protocol in this patient population.

Drugs for the acute treatment of migraine in children and adolescents

“…Pharmacologically, simple analgesics (NSAIDs, acetaminophen) and triptans do not have drug interactions and are medically safe to combine at the onset of a severe debilitating headache. While data to support the benefit of oral antiemetic add on therapy is currently lacking, based on IV antiemetic studies there may be a benefit to trialing oral antiemetics (ondansetron, metoclopramide) in patients requiring relief from nausea and vomiting in addition to migraine (11)(12)(13)(14).…”

Narrative review shows that the short‐term use of ketorolac is safe and effective in the management of moderate‐to‐severe pain in children

“…A total of 533 patients were identified with a discharge diagnosis of migraine headache, and 266 were enrolled. The mean initial verbal numeric pain score was 7.8, and the mean discharge verbal numeric pain score was 2.1, representing a 73% reduction in pain .…”

“…Of the 55 patients who were just treated with ketorolac, 80% experienced treatment success . Another retrospective study showed the safety and efficacy of a standardised paediatric migraine practice guideline for reducing pain in children with migraine headaches in the emergency department . Children with a verbal numeric pain score of greater than six received 0.5 mg/kg ketorolac (maximum 30 mg), 2 mg/kg diphenhydramine (max 50 mg) and either 0.2 mg/kg metoclopramide (max 20 mg) or 0.1 mg/kg prochlorperazine (max 10 mg).…”

Standardized Headache Therapy in the Pediatric Emergency Department Using Improvement Methodology

“…Migraine practice guideline usage in the PED has improved pain scores, 27 , 28 reduced length of stay (LOS), 28 and resulted in fewer admissions for refractory symptoms. 28 At our institution, we recognized the regular and variable use of multiple treatment strategies with little evidence to support their use.…”