Clinical Practice Guidelines: Migraine Headache


Migraine Headache (CPG)

Migraines are common in children with a prevalence of 4-11% in 7 to 11-year-olds and 8-23% by 15-years-old. Children often present to the emergency department (ED) with the chief complaint of headache or migraine. Randomized controlled trials for the treatment of pediatric migraine are lacking, and thus treatment is extrapolated from adult studies. As a result, physician practice patterns vary, leading to delays in medication administration and increased lengths of stay in the ED. For the month of January 2022, 27 patients had a primary diagnosis of migraine or primary headache. The average time to first medication administration was 107 minutes and length of stay in the ED was over 5 hours. The primary goal of this clinical practice guideline is to standardize treatment to reduce time to medication administration and length of stay in the ED. Additional measures of interest include the monitoring of home medications prescribed at discharge and referrals to outpatient neurology. 

Migraine Headache guideline team

  • Britta Roach, DO -  Emergency Medicine
  • Daisy Ciener, MD, MS - Emergency Medicine
  • Mariana Ciobanu, MD - Neurology 
  • Miles Fisher, DO  
  • Thomas Gilmartin, MD - Emergency Medicine
  • Lindsay Pagano, MD - Neurology
  • Melanie Whitmore, PharmD, BCPPS - Emergency Medicine

Suggested Metrics: 
•    Length of time to first-line treatment 
•    Disposition time 
•    Home medications at discharge 
•    Neurology follow-up 

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2.    Bachur RG, Monuteaux MC, Neuman MI. A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department. Pediatrics (Evanston). 2015;135(2):232-238. doi:10.1542/peds.2014-2432
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4.    Conicella E, Raucci U, Vanacore N, et al. The Child With Headache in a Pediatric Emergency Department. Headache. 2008;48(7):1005-1011. doi:10.1111/j.1526-4610.2007.01052
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8.    Szperka C. Headache in Children and Adolescents. Continuum (Minneapolis, Minn). 2021;27(3):703-731. doi:10.1212/CON.0000000000000993