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248 Migraine and undifferentiated headache
Pediatric:
n ibuprofen (10 mg/kg PO)
n acetaminophen (10–15 mg/kg PO)
n intranasal sumatriptan (5 mg IN if < 25 kg, 10 mg if 25–50 kg, 20 mg if > 50 kg)
Special cases:
n undifferentiated cephalalgia: antiemetic
n wish to avoid drowsiness: triptan (e.g. sumatriptan 6 mg SC)
n vascular disease presence or significant risk factors: avoid triptans
n nuisance adverse effects from SC sumatriptan: sumatriptan IN (20 mg IN)
n menstruation-associated migraine: triptan (e.g. sumatriptan 6 mg SC)
References
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Classification of Headache Disorders to the emergency department: an assessment
of reproducibility and the frequency with which a unique diagnosis
can be assigned to every acute headache presentation. Ann Emerg Med.
2007;49:409–419, e401–409.
2. Thomas S, Stone C. Emergency department treatment of migraine, tension,
and mixed-type headache. J Emerg Med. 1994;12:657–664.
3. Dihydroergotamine Nasal Spray Multicenter Investigators. Efficacy, safety, and
tolerability of dihydroergotamine nasal spray as monotherapy in the treatment
of acute migraine. Headache. 1995;35:177–184.
4. Dahlof C. Placebo-controlled clinical trials with ergotamine in the acute treatment
of migraine. Cephalalgia. 1993;13:166–171.
5. Gallagher RM. Acute treatment of migraine with dihydroergotamine nasal
spray. Dihydroergotamine Working Group. Arch Neurol. 1996;53:1285–1291.
6. Touchon J, Bertin L, Pilgrim AJ, et al. A comparison of subcutaneous sumatriptan
and dihydroergotamine nasal spray in the acute treatment of migraine.
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7. Colman I, Brown MD, Innes GD, et al. Parenteral dihydroergotamine for acute
migraine headache: a systematic review of the literature. Ann Emerg Med.
2005;45:393–401.
8. Lane R, Ross R. Intravenous chlorpromazine: preliminary results in acute
migraine. Headache. 1985;25:302–304.