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This clinical guideline outlines a standardized approach for assessing and treating patients who present to the emergency department with a suspected acute migraine. It provides step-by-step recommendations for medication selection, dosing, reassessment timelines, and escalation of care based on headache severity and clinical response. The pathway also identifies headache “red flags” that require further evaluation or specialist consultation.
Most Recent References
Randomized controlled trial of lidocaine occipital nerve blocks to treat status migrainosus in children/ adolescents (S22.009). Szperka CL, de Prado BM, Hsu J, Gelfand AA. Neurology. 2024;102(17_supplement_1):5487. doi: 10.1212/WNL.0000000000205849.
A randomized trial of ketorolac and metoclopramide for migraine in the emergency department. Richer LP, Ali S, Johnson DW, Johnson DW, Rosychuk RJ, Newton AS, Rowe BH. Headache. 2022;62(6):681–9. doi: 10.1111/head.14307.
A randomized controlled pilot study of intranasal lidocaine in acute management of paediatric migraine and migraine-like headache. Maki K, Doan Q, Sih K, Stillwell K, Chun A, Meckler G. Paediatr Child Health. 2022 Jun 23;27(6):340-345. doi: 10.1093/pch/pxac054.
