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These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly, these guidelines should guide care with the understanding that departures from them may be required at times.

Objective of the Guideline

The objective of the CPG is to standardize the care of children seen in the Emergency Department with a chief complaint of a migraine.

Target Users

Emergency Department/Urgent Care Center physicians, General Pediatricians, Pediatric Nurse Practitioners, and Hospitalists

Clinical Questions Answered by Guideline

1. In children who present to the ED with a refractory migraine headache, does getting a computed tomography (CT) scan versus not getting a CT scan change the management in the ED?

2. In the pediatric patient diagnosed with a refractory migraine, is prochlorperazine an effective treatment compared to ketorolac, metoclopramide, sodium valproate, IV magnesium?

3. In the pediatric patient diagnosed with acute migraine is valproic acid an effective treatment?

4. In the pediatric patient diagnosed with a refractory migraine, is DHE effective in the treatment of refractory migraine?

5. In patients with migraine, does treatment with intravenous magnesium sulfate alleviate headache?


Migraine; Refractory Migraine




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Pediatrics Commons