Childhood Migraine: A Practical Review

Gerald Silverboard, MD

Disclosures

February 28, 2002

In This Article

Status Migrainosus

Migraine that lasts 72 hours or more is known as status migrainosus. Treatment should include elimination of any inciting event, such as fever, infection, repetitive vomiting and resultant dehydration. Intravenous fluids provide access for IV administration of antiemetics and reestablishment of homeostasis. Prochlorperazine IV can control both nausea and pain.

In adolescents unable to retain oral medication, subcutaneous or intranasal sumatriptan may provide relief.[79] Intravenous DHE protocol is another consideration but should not be used if triptans were tried within 12 hours of the emergency room visit.[80] For severe headache, a brief course of steroids may be beneficial.

Physical measures such as rest in a quiet dark environment and use of oral triptans once vomiting is controlled may be sufficient to treat status migrainosus. TCAs may help improve sleep hygiene and provide analgesic relief as well. Use of narcotic analgesic should be minimized.

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