Migrane SSOU Admission Guideline
Definition
Migraine similar to previously established clear diagnosis but not responding to usual treatment
Admission Criteria
- Clear diagnosis, ie: similar recurrent headache in past diagnosed as migraine
- Previous normal CT
- Long established history of migraine
- Requires IV hydration
- Requires treatment
Exclusion Criteria
- Fever, unless there is a clear non-CNS focus
- Impaired consciousness level (GCS < 14)
- New focal neurological deficits
- sudden onset of headache indicating SAH
Investigations
Aimed at excluding SAH, tumour, meningitis. These conditions may be excluded clinically in many cases.
Consider:
- FBE
- UEC
- CTB
- ESR
- LP
Suggested Medications
Drug Dose Frequency Route Normal Saline 1L-2L to rehydrate IVI Aspirin (+/- codeine) 900mg 4 hourly oral Maxolon 10-20mg 6/24 IV Chlorpomazine 12.5-25mg in 1000mL NSaline Once over 1 hour IVI Sumitriptan 50-100mg Once Oral or Intranasal Dihydroergotamine 0.5-1mg once slow IV Magnesium should be considered if migraine linked to menstrual cycle Specific Observations
- Report drop in GCS by 1 point
- Headache/vomiting not controlled with maximal treatment
- Report new onset fever
Specific Management Issues
Discharge Criteria
- Pain free and controlled by oral analgesia
- Normal hydration
- Vomiting ceased
- Adequate social supports
- Diagnosis certain
Hospital Admission Criteria
- Headache not controlled by oral analgesia
- Development of new neurological deficit or failure of brief neurological deficit to resolve
- Impaired level of consciousness
- Poor social supports
