How is status migrainosus in children treated?

Updated: Jan 31, 2018
  • Author: William C Robertson, Jr, MD; Chief Editor: Amy Kao, MD  more...
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Answer

Answer

Aggressive therapy is needed but can often be administered in an outpatient infusion center. There are 5 principles of treatment: hydration, analgesia, specific antimigraine medication, antiemetics, and sedation.

Since vomiting and poor intake are almost always present, treatment begins with rehydration using glucose-containing fluids. An IV bolus of normal saline or lactated Ringer's solution followed by infusion of 5-10% dextrose solution should be considered.

Analgesic options should include relatively mild pain medications such as intramuscular (IM) ketorolac or rectal suppositories of naproxen or indomethacin. If possible, narcotics should be avoided.

First-line, migraine-specific regimens include triptans, IV valproic acid (Depacon), and IV DHE; however, these agents should not be used together. In addition, the use of IV DHE in patients younger than 12 years is questionable; in this age group, many patients respond to IV fluids and lorazepam. Subcutaneous (SC) sumatriptan (0.06mg/kg, maximum dose 6mg) may be useful in patients unable to tolerate oral medications.

Similarly, in patients weighing less than 50kg, be sure to appropriately titrate the dose of IV medications.


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