In the pediatric patient diagnosed with a refractory migraine, what is the efficacy of DHE IV to decrease migraine pain in the Emergency Department?
Plain language summary from the office of evidence based practice: Based on very low quality evidence the Migraine in the ED CPG Teams makes a conditional recommendation against the use of DHE as the first line treatment of refractory migraine in the ED. However, it may be considered if:
Hospital admission is anticipated
Triptans have not been administered in the previous 24 hours
Subsequent doses of DHE can be administered
The key points are:
Response to treatment with DHE may not be apparent until after the fifth dose and it is dosed every 8 hours (Kabbouche, et al., 2009)
DHE cannot be given if the patient has received triptans with the previous 24 hours (Lexi-Comp, 2016)
IV: 1mG, repeat 8 hours, improvement usually seen after the fifth dose
IM/SC: 0.5- 1mG, repeat hourly if needed (max 3mG/day)
Nasal: 0.5mG each nostril Q15 min (max 3mG/day)
See Appendix D for the full Critically Appraised Topic (CAT).