What is included in inpatient care for migraine in children?

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

Patients with persistent status migrainosus can be admitted to the hospital; therapy may be repeated every 8 hours for up to 48 hours. In one study, 49 of 55 DHE-treated patients became headache free within 48 hours, and 39 of these patients sustained the benefits for a mean follow-up period of 16 months.

Clinical observations have suggested that IV prochlorperazine [20] (5-10mg) or metoclopramide (10mg) followed by 0.1-0.5 mg of IV DHE may be effective. Dosage is age dependent and may be repeated in 1 hour if needed. An alternative is to give an IV bolus of valproate (20-30mg/kg) followed by a continuous infusion of 1-2mg/kg for 24 hours.

Finally, sedation is an important component of treatment, especially in refractory cases. Sleep has long been recognized as beneficial in migraine. IV diphenhydramine (25-50mg) can be effective and should be considered when metoclopramide is the antiemetic of choice. IV benzodiazepines have sedative and anxiolytic properties and therefore are also useful in migraine status.


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