Comprehensive Migraine Initiative Improves Emergency Department Management of Pediatric Migraine


A standardized treatment protocol in emergency departments lead to significant reductions in headache pain.

Chris Oakley, MD

Chris Oakley, MD

Implementation of a comprehensive migraine initiative resulted in a higher percentage of patients achieving a significant reduction in pain, as well as a significant reduction in headache pain score, according to findings from a single-center retrospective analysis.

In order to assess pediatric migraine treatment efficiency in the emergency department, investigators observed before and after effects of a comprehensive migraine initiative, including a standardized treatment protocol, provider educational series, and standardized physician documentation template, which consisted of focused questions about the patient’s headache, and the examination section defaulted to a normal neurologic examination.

The intervention and preintervention groups included 110 patients each. The investigators specifically looked at initial and final headache pain scores, time spent in the emergency department, and time elapsed until first treatment given. Patients were assessed on a scale of 0 to 10 for headache pain severity, with 10 being the most extreme pain.

Between the preintervention and intervention groups, there were no significant differences in patient characteristics such as age, gender, and initial headache pain score. The intervention group was 70% female, compared to 61% in the preintervention group.

Among the 2 groups, 5.9% of patients in the intervention group had a significant decrease in headache pain score, compared to just 4.8% in the preintervention group (P = .006). The time to treatment was 1.8 and 2.1 hours in the intervention group and preintervention group, respectively (P = .046).

Notably, the mean percentage in pain reduction for patients in the intervention group was 75.7% compared to 63.3% in the preintervention group. A total of 82 patients in the intervention group reported a >50% pain reduction, 15 more than that of the preintervention group. Although there was a 6.4% higher frequency of hospital admissions in the intervention group, investigators believed the results are not statistically significant.

The investigators concluded that through a standardized, updated treatment protocol, migraine treatment in an emergency room environment can be improved. They also noted that further studies to assess factors that influence headache recurrence in the immediate period following discharge are needed.

“By creating a streamlined headache protocol and optimizing provider education surrounding the acute management of pediatric migraine, we showed not only significantly reduced pain scores but also reduced patient wait time to receive initial treatment,” the study authors concluded.


Skora CE, Worden LT, Oakley CB. Comprehensive migraine initiative in the pediatric emergency department improves treatment outcomes. J Child Neurol. Published online December 5, 2019. doi:10.1177/0883073819889711.

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