UMEM Educational Pearls

Title: Pediatric Migraines...what a headache!

Posted: 8/31/2018 by Rose Chasm, MD
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Migraine diagnosis should only be made after other serious intracranial diagnoses have been ruled out.
Pediatric migraine is a difficult diagnosis to make before the age of 7 years, due to communication difficulties
Avoid opiates and barbiturates. They have not proven to be effective, and have been shown to decrease the effectiveness of future triptan treatments.
First line treatment for mild to moderate migraines is acetaminophen and/or NSAID's. The addition of caffeine, has been shown to potentiate the analgesic effects of both.
First line treatment for moderate to severe migraines is triptans.
Most pediatric migraines presenting to the ED, are severe migraines that have failed the above abortive home treatments and have persisted for 24+ hours. These patients often require intravenous therapy.
Dopamine receptor antagonist, specifically Prochlorperazine, 0.15mg/kg, 10mg max, has demonstrated the greatest effectiveness. Consider administration with diphenhydramine, 1mg/kg, 50mg max to prevent dystonic reactions.
Concomitant dexamethasone, 0.6mg/kg, 20mg max administration has been shown to decrease acute recurrence.
If prochlorperazine fails, other alternatives include Sumatriptan, 5-20mg IN, 50-100mg PO and lidocaine, 0.5mL of 4% solution IN.
IVF hydration, and reduction of light and sound stimuli may be helpful.

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Gelfand, A. Treatment of pediatric migraine in the emregency department. Ped Neuro.2012;47(4)233-241.

Kacperski, J. The optimal management of headaches in chidlren and adolescents. Ther Adv Neuro Disor. 2016;9(1)53-68.

Sheridan, D. Pediatric Migraine: Abortive treatment in the emergency department. Headache. 2014;54(2):235-245.