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Migraine – ED management — RACP Paediatrics MCQ

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ModerateNeurologyMigraine – ED managementRACP Paediatrics

A 15-year-old with migraine presents to the ED with a severe attack that has not responded to oral ibuprofen and paracetamol. She is vomiting. What is the most appropriate ED treatment?

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Correct answer: A — Sumatriptan nasal spray

For adolescents (≥12 years) with moderate-severe migraine unresponsive to simple analgesics, sumatriptan nasal spray (10-20 mg) is recommended as the preferred triptan formulation in children (better than oral due to vomiting). IV prochlorperazine or IV ketorolac are alternatives in the ED setting.

Reference: RCH Melbourne – 2023 – Headache CPG; Australian Therapeutic Guidelines – 2024 – Neurology